Surgery or Radiation improves survival compared to observation of localized prostate cancer.

A recently published study analyzed the outcomes of 3,159 men treated either conservatively or with radiotherapy or radical prostatectomy (RP) in the years 1980 to 1997. The study shows that men with localized prostate cancer treated with surgery (radical prostatectomy, RP) or radiation had improved survival compared to men who chose observation, despite the fact that the men who chose treatment had more aggressive cancers.

Participants were younger than 75 years and had socioeconomic, clinical, pathological and demographic data reviewed. Men with positive bones scans were excluded. The primary endpoint was death from all causes and the secondary endpoint was death from prostate cancer. Radiotherapy or RP had to be received by the patient within 6 months of diagnosis.

Surgery reduced the 15-year mortality rate by 59% overall and by 47%, 60%, and 65% for men with grade 1, 2, and 3 tumors, respectively. The overall survival advantage was 8.6 years and was 6.8, 5.5, and 10.4 years for patients with grade 1, 2, and 3 disease, respectively. Radiotherapy patients also experienced a survival advantage with a reduction in mortality of 33%. The survival advantage was also found for CaP-specific survival. Radiotherapy or RP reduced the death rate from CaP by 38% and 63%, respectively, compared with patients treated conservatively.

These results may seem obvious, but there is vigorous ongoing debate about the benefit of aggressive treatment of localized prostate cancer. This is just the latest in a series of studies that show an advatage for treatment, particularly in younger patients and men with at least 10 years of life expectancy.