The Tyrol Prostate Cancer Demonstration Project (1988 - 2007): Morbidity And Mortality

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 01 Jul 2008 - 2:00 PDT

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ORLANDO, FL (UroToday.com) - Although reduction in prostate cancer mortality rates is important, it is necessary to consider the effects of prostate cancer screening and treatment on patient quality of life. Potential gains in survival could be more than offset decrements in quality of life that may result from diagnosis and treatment.

In 1988, the concept of early detection and curative radical therapy for prostate cancer was introduced in the Tyrol. In 2005 a cumulative testing rate of 86.6% was achieved. Overall 7439 TRUS guided biopsies were performed; before 1998 ten biopsies were performed using contrast-enhanced color Doppler ultrasound. In men with organ-confined lesions, surgical removal of the prostate was recommended. 89.3% of patients with T1 or T2 disease were treated with low-morbidity radical prostatectomy, 5.7% with brachytherapy, and 4.7% with radiotherapy. Between 1988 and 2007 2003 radical prostatectomies were performed mostly by two surgeons (G.B., W.H.). Patients presenting with T3 lesions underwent external beam radiotherapy.

Radical prostatectomy has been associated with low morbidity; 30-day mortality was zero and one of the patients suffered a ureteral injury. The rectal injury rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients had postoperative bleeding requiring intervention. One year after surgery, 95.1% of men were continent (no pads) and potency could be preserved in 78.9% of men below 65 years of age. The morbidity associated with TRUS guided biopsy was low; major complications were seen in a small percentage of patients only (0.5% of patients with fevers higher than 100.4 degrees F requiring hospitalization). Since 1996 a significant reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality rates decreased by 48%, 55%, and 52%, respectively.

The investigators conclude that these findings confirm the hypothesis that freely available PSA testing, which has met with wide acceptance in the population, is associated with a reduction in prostate cancer mortality in an area where effective treatment is freely available to all men. It is likely that much of this decline in mortality rates is due to earlier detection and successful treatment of prostate cancer. However, an important corollary of this study is that screening is only the first step in the optimal management of prostate cancer.

Presented by Georg Bartsch, MD, Wolfgang Horninger, MD, Helmut Klocker, MD, Wilhelm Oberaigner, MD, Georg Schaefer, MD, Ferdinand Frauscher, MD, Chris Robertson, MD, Peter Boyle, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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