Elsevier

Urology

Volume 68, Issue 6, December 2006, Pages 1268-1274
Urology

Adult urology
Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy)

https://doi.org/10.1016/j.urology.2006.08.1059Get rights and content

Abstract

Objectives

To report the long-term survival probability in more than 3000 men with localized prostate cancer treated either conservatively or by definitive treatment (radiotherapy or radical prostatectomy).

Methods

We studied 3159 men with biopsy-confirmed, clinically localized prostate cancer diagnosed from 1980 to 1997. We restricted our analysis to men 75 years of age or younger. The extent of comorbid disease was measured using the Charlson score. The Cox proportional hazards regression model was used to compare long-term survival in patients who were treated conservatively versus survival in patients treated with either radiotherapy or radical prostatectomy.

Results

After adjusting for age, race, tumor grade, comorbid disease, income status, and year of diagnosis, the overall survival rate at 15 years was 35% for conservative management, 50% for radiotherapy, and 65% for radical prostatectomy. The corresponding prostate cancer-specific survival rates were 79%, 87%, and 92%. Patients undergoing radiotherapy or radical prostatectomy had lower overall mortality than patients undergoing conservative management (adjusted relative risk 0.67 for radiotherapy and 0.41 for prostatectomy; P <0.001). The increase in the survival duration was 4.6 years with radiotherapy and 8.6 years with radical prostatectomy.

Conclusions

The results of this study have shown that compared with conservative management, both radiotherapy and radical prostatectomy increase survival for men with localized prostate cancer.

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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