Prostatectomy confers the best chance of long-term prostate-cancer-specific survival
Original article
Merglen A et al. (2007) Short- and long-term mortality with localized prostate cancer. Arch Intern Med 167: 1944–1950 PubMed
The best method for managing localized prostate cancer is currently unclear, as randomized trials are yet to determine which strategy produces the best long-term outcome. In the absence of convincing trial data, in a population-based cohort study that was carefully controlled for confounding factors Merglen et al. have demonstrated that surgery confers the best chance of long-term prostate-cancer-specific survival.
All 844 patients diagnosed with localized prostate cancer between 1 January 1989 and 31 December 1998 in Geneva, Switzerland, were enrolled in this study; 47 patients were later lost to follow-up. In total, 158 patients underwent prostatectomy, 205 underwent radiotherapy, 378 were managed using a strategy of watchful waiting, 72 received hormone therapy, and 31 were managed using other treatment regimens. The mean duration of follow-up was 6.7 years. Cox proportional hazards analysis, adjusted for age, sector of care, period of diagnosis, method of detection, lymph-node status, clinical tumor stage, tumor differentiation, and PSA value, revealed that management strategy influenced 5-year prostate-cancer-specific mortality only slightly. By contrast, long-term prostate-cancer-specific mortality was strongly influenced by treatment option. In comparison with patients who underwent prostatectomy, significantly increased risks of death from prostate cancer at 10 years were seen in patients who underwent radiotherapy (hazard ratio [HR] 2.3, 95% CI 1.2–4.3; P <0.05), hormone therapy (HR 4.4, 95% CI 2.2–8.8; P <0.001) or watchful waiting (HR 2.0, 95% CI 1.1–3.8; P <0.05). The long-term cancer-specific survival benefit associated with surgery was even more apparent in those patients younger than 70 years old and in those with poorly differentiated tumors.
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