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No Simple Answer for Localized Prostate Cancer.
Prostate-specific antigen (PSA) screening has spawned a marked increase in diagnoses of clinically localized prostate cancer, but the best management strategy has been elusive. Two recent studies examine treatment options and outcomes.
A U.S. retrospective analysis compared outcomes among 1,872 men treated for localized prostate cancer. Among low-risk patients (stage T1c, T2a, and PSA 10 ng/ml or lower and Gleason score 6 or lower), outcomes were excellent with radical prostatectomy, external beam radiation therapy, or implant with or without neoadjuvant hormonal therapy. Patients with worse prognostic profiles did better with radical prostatectomy or radiation therapy than with implants.
In an analysis of data on 767 North American men with localized prostate cancer who were followed up to 20 years with conservative management (no surgery, brachytherapy, or radiation; some received hormone therapy), Gleason scores were closely correlated with risk for dying from prostate cancer within 15 years of diagnosis. Men with Gleason scores of 2 to 4 had only a 4 percent to 7 percent risk of death from prostate cancer over that period.
Comment: The second study demonstrated good outcomes in clinically localized low-grade prostate tumors treated conservatively, so it's not surprising that outcomes among low-risk patients in the first study were the same for various treatments. The best intervention for more aggressive tumors remains uncertain and will probably be identified only through long-term randomized trials, now underway.
— TH Lee
Published in Journal Watch General Medicine October 6, 1998
Citation(s):
D'Amico AV et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998 Sep 16 280 969-974.
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Albertsen PC et al. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 1998 Sep 16 280 975-980.
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- Medline abstract (Free)