Surgery effective for aggressive prostate cancer patients: Study

Surgery provides high survival rates for patients with aggressive prostate cancer, says a new study.

The study is one of the first to focus exclusively on the outcomes after treatment for patients with high-risk prostate cancer.

Collaborating researchers at Mayo Clinic and Fox Chase Cancer Centre in Philadelphia discovered that patients with the most aggressive forms of prostate cancer who had radical prostatectomy procedures had a 10-year cancer-specific survival rate of 92% and an overall survival rate of 77%.

The cancer-specific survival rate for patients who had radiation therapy alone was 88% and the overall survival rate was 52%.

"Earlier it was believed that patients with aggressive prostate cancer are not candidates for surgery. But we found that surgery does provide excellent long-term cancer control for this type of prostate cancer," said Dr Stephen Boorjian, a Mayo Clinic urologist.

"In addition, by allowing the targeted use of secondary therapies such as androgen deprivation, surgery offers the opportunity to avoid or at least delay the potentially adverse health consequences of these treatments."

Of the 1,847 patients with aggressive prostate cancer (as defined by the National Comprehensive Cancer Network) 1,238 underwent surgery at Mayo Clinic and 609 were treated with radiation therapy at Fox Chase Cancer Centre as part of the study which was conducted from 1988 to 2004.

Of the 609 receiving radiation therapy, 344 also received androgen deprivation therapy.

Researchers analysed their cancer-specific and overall survival rates. The cancer-specific survival rate was equal for those who had surgery and those treated with radiation plus hormone therapy (92%).

But the overall survival rate was significantly better for those who had the surgery (77%) than those who had radiation plus hormones (67%), or those who had radiation alone (52%).

Patients with radiation and hormone therapy were 50% more likely to die than patients who had surgery. This was true even after controlling for patient age, co-morbidities and features of the tumours.

"These results suggested that the use of hormone therapy in patients who received radiation therapy may have had adverse health consequences," said Boorjian.

"We want to stress that surgery provides excellent long-term control for high-risk prostate cancer patients. Limiting the need for hormones may avoid adverse health consequences.

"Further studies evaluating the differing impacts of treatments on quality of life and non-cancer mortality are necessary before we can determine the best approach for patients with aggressive prostate cancer," he added.

The findings were presented at the north-central section of the American Urological Association's 84th annual meeting held in Chicago.