MedicineWorld.Org
Your gateway to the world of medicine
Home
News
Cancer News
About Us
Cancer
Health Professionals
Patients and public
Contact Us
Disclaimer

Medicineworld.org: Surgery, radiation or hormone

Back to prostate Blogs list Cancer blog  


Subscribe To Prostate RSS Feed  RSS content feed What is RSS feed?

Surgery, radiation or hormone




Surgery for localized prostate cancer offers a significantly higher survival rate than either external-beam radiation or hormonal therapies, as per a newly released study led by scientists at UCSF.

The differences among therapies were more prominent at higher levels of cancer risk, and suggest, the scientists say, that in a number of cases surgery should play a greater role in therapy strategies for prostate cancer patients that is likely to recur or spread.

The study is available online in the journal "Cancer," the journal of the American Cancer Society, at this site



Surgery, radiation or hormone

Most prior reports comparing therapy outcomes among different therapy options have looked only at PSA responses to therapy, rather than at the more important long-term survival outcomes, as per the researchers. Measuring levels of PSA, or prostate-specific antigen, in the blood, is intended to help determine whether prostate cancer has recurred or spread, eventhough in a number of cases a rising PSA level does not necessarily mean the cancer will progress.

Roughly one man in six will be diagnosed with prostate cancer, which is the second leading cause of cancer death in American men, as per the American Cancer Society.

"Despite the high occurence rate of prostate cancer, there is relatively little high-quality evidence on which to base current therapys for localized disease," said Matthew R. Cooperberg, MD, MPH, lead investigator of the study and a prostate cancer specialist in the UCSF Department of Urology and the UCSF Helen Diller Family Comprehensive Cancer Center.

"These therapies can all have significant side effects, so it's important to understand which therapy alternatives are most effective. In current practice, likelihood of undergoing surgery falls progressively with increasing levels of risk, which appears to be exactly contrary to what the therapy pattern should be," he said.

Scientists observed that the risk for cancer-specific mortality was more than three times higher in patients who received hormone treatment versus radical prostatectomy (surgical removal of the prostate) and more than twice as high in patients who received external-beam radiation treatment versus prostatectomy.

For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the therapy options were small. The survival differences increased substantially for men at intermediate and high risk, as per the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk.

The American Urological Association's clinical practice guidelines for localized prostate cancer therapys include active surveillance, radical prostatectomy, external-beam radiation treatment, and brachytherapy (radiotherapy delivered via radioactive seeds), but draw no conclusions about the relative efficacy of each.

Androgen-deprivation treatment, which suppresses the production of male sex hormones, is not endorsed by the American Urological Association clinical practice guidelines for localized prostate cancer, due to inadequate evidence regarding outcomes, yet it is usually used in practice, the scientists state.

"This is a clear signal to the doctor community that prostatectomy should be considered for men with higher-risk prostate cancer. In a number of cases, surgery would be part of a multimodal therapy approach, including adjuvant radiation or systemic therapys based on the pathology and early PSA response," added Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology and leader of the Prostate Program at the UCSF Helen Diller Family Comprehensive Cancer Center. Carroll is senior author on the paper.

Because no adequate randomized trials have compared active therapys for localized prostate cancer, the authors analyzed risk-adjusted, cancer-specific mortality outcomes among men who underwent radical prostatectomy, external-beam radiation treatment, or primary androgen deprivation.

The research team analyzed data from 7,538 men with localized disease from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, a national disease registry comprising men from 40 urologic practice sites from across the country. The team then compared outcomes across therapys after adjusting for risk and age. In total, 266 men died of prostate cancer during follow-up.


Posted by: Mark    Source




Did you know?
Surgery for localized prostate cancer offers a significantly higher survival rate than either external-beam radiation or hormonal therapies, as per a newly released study led by scientists at UCSF. The differences among therapies were more prominent at higher levels of cancer risk, and suggest, the scientists say, that in a number of cases surgery should play a greater role in therapy strategies for prostate cancer patients that is likely to recur or spread.

Medicineworld.org: Surgery, radiation or hormone

Comprehensive| Diagnosis of bladder cancer| Follow up of bladder cancer| Bladder cancer main| Overview of bladder cancer| Risk factors for bladder cancer| Screening for bladder cancer| Symptoms of bladder cancer| Treatment of bladder cancer|

Copyright statement
The contents of this web page are protected. Legal action may follow for reproduction of materials without permission.