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Prostatectomy May Not Be Necessary for Some Patients NEW YORK -- July 28, 2009 -- In a study published online in the Journal of Clinical Oncology, researchers found that in a group of 12,677 men who had radical prostatectomies between 1987 and 2005, the 15-year mortality rate that could be directly linked to prostate cancer was only 12%, even though many of the patients' cancers had aggressive features. Comparatively, the rate of non- cancer-related death in this group was 38%. A small fraction, 4%, of patients treated surgically within the past 10 years had a 5% or greater risk of dying of prostate cancer within 15 years. It is not clear at this time whether the outcomes may be related to the effectiveness of surgery and any secondary therapy, or to the low lethality of certain types of prostate cancers to begin with. "The importance of this paper is that it shows a remarkably low risk of dying of prostate cancer within 15 years for treated men, and supports the concept that men with slow-growing cancers may not need immediate treatment," said senior author Peter Scardino, Department of Surgery, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, New York. "Further good news is that surgery was very effective in preventing death in men with aggressive cancers -- defined as those with a high PSA, poorly differentiated with a Gleason grade of 8 to 10, or locally extensive." "Currently, there are a number of tools physicians have to help determine the probable course of prostate cancer, but more accurate ones are needed," he added. "In the future, what we'd like is to be able to do a molecular or genetic analysis of prostate tumour cells to see if they have the capacity to spread, so that we can ask, does your tumour have that capacity? If not, it would be safe to watch," said Dr. Scardino. As part of the study, 12,677 patients treated with radical prostatectomy between 1987 and 2005 were tracked. Of these patients, 6,398 underwent radical prostatectomy for localised prostate cancer, with 809 (13%) receiving neoadjuvant androgen-deprivation therapy for an average of 3.2 months. External validation of the nomogram was performed on 4,103 patients treated at Cleveland Clinic, Cleveland, Ohio, and 2,176 patients treated at University of Michigan, Detroit, Michigan, during the same period. Prostate biopsy specimens were reviewed by pathologists at each institution before surgery. In general, patients were followed for disease recurrence post operatively with regular PSA tests and clinical exams at 3 to 6 month intervals for the first 5 years, and then annually. The year of surgery was also a consideration, as methods and effectiveness have changed over the years. SOURCE: Memorial Sloan-Kettering Cancer Center E-mail this page to a friend or colleague! To print, use this version