Adult urologyLong-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy)
Section snippets
Study Population and Design
All patients with localized prostate cancer treated in the Henry Ford Health System from 1980 to 1997 were included in this study.6, 7 The Henry Ford Health System corporate data stores, hospital records, tumor registry, and the Surveillance, Epidemiology and End Results databases were used to collect relevant variables. We identified 4387 eligible patients. Of these, 1012 patients were older than 75 years, 4 men were neither black nor white, and 212 had incomplete biopsy grade or income
Study Population Characteristics
Of the 3159 men, 42% were treated conservatively, 28% received radiotherapy, and 30% underwent radical prostatectomy (Table I). Patients treated conservatively or with radiotherapy were older (mean age ± SD 66.2 ± 6.5 years for conservative management, 67.8 ± 5.7 years for radiotherapy) than patients who underwent radical prostatectomy (63.1 ± 6.3 years). Patients treated conservatively or with radiotherapy were also sicker (ie, had greater Charlson scores: 1.5±1.2 for conservative management
Comment
In our large, long-term cohort study, patients with localized prostate cancer treated with radiotherapy or radical prostatectomy survived longer than those treated conservatively. Radiotherapy resulted in a 33%, and prostatectomy a 59%, reduction in overall mortality at 15 years. This translated into an increase in median survival of 4.6 years for patients undergoing radiotherapy and 8.6 years for those treated with radical prostatectomy. The survival advantages persisted after adjusting for
Conclusions
We have demonstrated that both radiotherapy and radical prostatectomy improve survival in patients with localized prostate cancer. It is important to note that this was a retrospective study with the limitations noted above. However, pending the results from randomized controlled trials, we have concluded that in men with localized prostate cancer, both radical prostatectomy and radiotherapy offer greater survival benefits than conservative management.
Acknowledgment
To Jackson Fowler, M.D. and Mark Kelly, M.D. for their valuable suggestions during the study and manuscript preparation; to all the members of the faculty at the Department of Urology, who treated these patients during the past 20 years; to the entire resident staff for sharing some of the day-to-day clinical work during completion of this project; to the entire staff of the Josephine Ford Cancer Center for the cancer research grant and support for the completion of this study; and, last but
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