Surgery For Aggressive Prostate Cancer Gives 92% 10-year Survival Rate

Patients with the most aggressive form of prostate cancer who have surgery - radical prostatectomy - were found to have a 10-year cancer-specific survival rate of 92%, which is high, and a 77% overall survival rate, according to researchers from the Fox Chase Cancer Center and the Mayo Clinic, USA. This compares to an 88% 10-year cancer specific survival rate and 52% overall survival rate for those who underwent radiotherapy without surgery. The findings were presented at the American Urological Association's 84th Annual Meeting, Chicago.

Stephen Boorjian, M.D., a urologist at the Mayo Clinic, said:

It's long been believed that patients with aggressive prostate cancer are not candidates for surgery. We found that surgery does provide excellent long-term cancer control for this type of prostate cancer. 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.

Their study included 1,847 individuals with aggressive prostate cancer. Between 1988 and 2004 1,238 of them underwent a surgical procedure to have their prostate taken out (radical prostatectomy) at the Mayo Clinic, while 609 received radiotherapy at the Fox Chase Cancer Center. 344 of the patients who received radiotherapy were also given androgen deprivation therapy.

The investigators worked out their overall and cancer-specific survival rates:

• Patients who underwent surgery had a 92% cancer-specific survival rate, as did those who received radiotherapy plus androgen deprivation therapy (hormone therapy)
• 77% of those who had surgery had a 77% overall survival rate
• Those who received radiotherapy plus hormone therapy had an overall survival rate of 67%
• Patients who had just received radiation therapy (radiotherapy) had an overall survival rate of just 52%

Dr. Boorjian said:

Patients with radiation and hormone therapy were 50 percent more likely to die than patients who had surgery. This was true even after controlling for patient age, comorbidities and features of the tumors. These results suggest that use of hormone therapy in patients who received radiation therapy may have had adverse health consequences.

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.