Longer Survival Rates After Surgery For Prostate Cancer Patients
Editor's ChoiceMain Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology; Cancer / Oncology; Radiology / Nuclear Medicine
Article Date: 09 Oct 2007 - 0:00 PDT
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A higher percentage of prostate cancer patients who undergo surgery survive for at least ten years than patients who opt for other forms of treatment, this is especially the case for younger patients, and those with specific tumor characteristics. You can read about this in Archives of Internal Medicine (JAMA/Archives), October 8th edition.
As prostate cancer treatments have not yet been compared in a randomized trial, the topic still hotly debated, "Therefore, treatment choice is strongly influenced by patient and physician personal preferences and experiences," explain the authors.
Arnaud Merglen, M.D., of Geneva University, Switzerland, and team collected information from the Geneva Cancer Registry and assessed 844 patients who had localized prostate cancer in Geneva during the period 1989-1998. Localized prostate cancer means it has not spread yet. 158 of these men had undergone surgery to remove part or all of the prostate, 205 had received radiotherapy, 375 opted for watchful waiting (active follow-up treatment if the disease advances), 72 received hormone therapy, while 31 were treated with another type of therapy.
The follow up period ranged from 0 to 15.8 years and averaged 6.7 years. 47 of the men had left Geneva before the end of the study.
"At 10 years, patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy," the researchers wrote.
The patients' ten year survival rates were as follows:
-- Prostatectomy (surgery) 83%
-- Radiotherapy 75%
-- Watchful waiting 72%
-- Hormone therapy 41%
-- Other treatment 71%
"The increased mortality associated with radiotherapy and watchful waiting was primarily observed in patients younger than 70 years and in patients with poorly differentiated tumors," explained the authors. Also, tumors that have specific cellular characteristics that make them spread more aggressively also increase mortality.
The researchers concluded "Until clinical trials provide conclusive evidence, physicians and patients should be informed of these results and their limitations."
Short- and Long-term Mortality With Localized Prostate Cancer
Arnaud Merglen, MD; Franz Schmidlin, MD; Gerald Fioretta, BSc; Helena M. Verkooijen, MD, PhD; Elisabetta Rapiti, MD, MPH; Roberto Zanetti, MD; Raymond Miralbell, MD; Christine Bouchardy, MD, MPH
Arch Intern Med. 2007;167(18):1944-1950.
Click here to view abstract online
Written by: Christian Nordqvist
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retrospective studies can not be used to make determine future outcome of generic treatments
posted by Fred Kinder on 22 Aug 2009 at 1:29 amThis study 1989-1998 points out why retrospective studies can not be used to make determine future outcome of generic treatments.
Radiation is a very wide range of therapies that is constantly changing improving, the shape of the prescribed dose gets better with better planning software and beam delivery and shaping hardware. This allows increased prescribed dose that increases the cancer kill factor.
Today treatments like the CyberKnife use 100's of beams that converge to make a very uniform and defined dose volume with rapid dose fall-0ff. This allows hopofractionation (higher dose per session) improving cancer kill power and likely most important tracks the movement of the prostate during treatment to automatically adjust the beam to track the target. Result is maximum kill factor while minimizing collateral damage to surrounding critical structures.
Surgery has not enjoyed the same advancement. Robotic treatment has not proven improved outcome.
The total dose volume from 1989 to 1998 was 60 to 70 Gy
with hot and cold spots in the prescribed dose volume and out side the dose volume.
Today IMRT total dose volume is 80-86.4Gy (8 weeks of daily treatments -40 typical) with improved dose volume shape and improved delivery to dose plan to traget volume. The cure rate is getting better and toxicity is being reduced.
The CyberKnife total dose volume is 36.26 to 38Gy 4 or 5 treatment sessions (days). Because of the increased dose per session the kill factor is again improved and collaterial damage is reduced.
The point of all this is the surgery was a good choice and in this study.
Today based on the improvememts the CyberKnife is a very good choice.
With all radiation(photons or protons) the outcome and toxicity are not known until many hears later. So all of this is a moving target with radiation improving with computer technology and surgery about the same outcome as years ago.
May your PSA never rise
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