Outlook Good for Most Prostate Cancer Patients

Long-term survival rate high after surgery

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HealthDay Reporter

TUESDAY, May 11, 2004 (HealthDayNews) -- The outlook for most men diagnosed with prostate cancer is good, especially for those who have surgery to remove the gland, according to new studies just reported at the annual meeting of the American Urological Association.

A study of patients treated at Memorial Sloan-Kettering Cancer Center in New York City found "this operation has the ability to cure three of every four men, 15 years after the diagnosis," said Dr. Fernando J. Bianco, Jr., an oncology fellow at the center who delivered the report.

Even for men in whom the cancer recurs after surgery, "the chances that they will make it to 15 years is very high," Bianco said.

Recurrence is indicated by a rising level of prostate-specific antigen (PSA), a protein produced by both normal and cancerous prostate tissue. However, the PSA test is not the best and only indicator of prostate cancer

"Even for those who developed a rising PSA after radical prostatectomy, the probability of death from cancer at 10 and 15 years was 23 percent and 38 percent," Bianco said.

The study included 1,700 men who had radical prostatectomy, an operation to remove the cancerous gland, since 1983. The cancer recurred in only 261 of them.

Even when the cancer had spread beyond the prostate to nearby lymph nodes or elsewhere in the body when it was first diagnosed, the 15-year survival rate was 70 percent or better, the study found.

A study of more than 3,000 prostate cancer patients at the Washington University School of Medicine in St. Louis also demonstrated the effectiveness of cancer surgery. That study compared survival rates for men treated by surgery, external beam radiation, hormonal therapy or brachytherapy -- in which radiation-emitting pellets are implanted in the body -- and for cases in which the physician chose watchful waiting.

Only 13 percent of men classified as low-risk because the cancer was confined to the prostate at the time of diagnosis had died after an average follow-up time of 68 months. The mortality rate for men at intermediate risk because the cancer had spread to nearby lymph nodes was 20 percent. For high-risk men, in whom the cancer had spread further, the death rate was 41 percent.

Brachytherapy also gave encouraging results, with a mortality rate of less than 10 percent of low-risk men and 17 percent of intermediate-risk men in a 42-month follow-up. But the death rate for high-risk men treated with brachytherapy was 59 percent.

Results for external beam radiation were less impressive, with a five-year survival rate for low-risk men of 83 percent. Survival rates for low-risk men treated with hormonal therapy and watchful waiting were much lower. Because of the relatively small number of patients, the survival estimates were very broad -- between 23 and 71 percent for hormonal therapy and 22 and 56 percent for waiting.

While the results of surgery are good, "it is hard to make a statement in favor of just one treatment," said Dr. Misop Han, a staff urologist at Northwestern Memorial Hospital in Chicago, who has worked with the Washington University physicians and delivered another report at the meeting.

"There is a role for radiation therapy and hormone therapy and watchful waiting," Han said. "It depends on the characteristics of the individual patient."

Han's paper covered radiation treatment of men who experienced recurrence of cancer after surgery. The salvage radiation treatment eliminated the cancer in only 25 percent of those men in a 10-year follow-up, but many of those men were still alive, Han said, so "the mortality rate data are not mature yet."

The study shows that recurrence of prostate cancer "can be effectively treated with salvation radiation therapy in properly selected patients," Han said.

More information

What you need to know about prostate cancer is outlined by the National Cancer Institute, while the American Cancer Society discusses treatment options.

SOURCES: Fernando J. Bianco Jr., M.D., oncology fellow, Memorial Sloan-Kettering Cancer Center, New York City; Misop Han, M.D., staff urologist, Northwestern Memorial Hospital, Chicago; May 9-10, 2004, presentations, American Urological Association annual meeting, San Francisco

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