Study compares prostate treatment options

Patients with intermediate-risk or high-risk prostate cancers may fare better with certain treatment options than others, although there is little difference in treatment outcomes for patients with low-risk prostate cancer, according to an article in a recent issue of The Journal of the American Medical Association (JAMA).

Anthony V. D'Amico, M.D., Ph.D., of Harvard Medical School in Boston, and colleagues studied 1,872 men treated with three different treatment options for prostate cancer: radical prostatectomy (RP), a surgical procedure that removes the entire prostate gland and some of the tissues around it; external beam (RT) radiation therapy, which uses high-dose X-rays from a source outside the body to kill the cancer cells; and interstitial radiation (implant), another form of radiation therapy where radioactive "seeds" are permanently placed inside the prostate.

The researchers measured the prostate specific antigen (PSA) levels, a blood test used to monitor the progress of the cancer, in men after they had undergone one of the three treatments to determine the effectiveness of the implant with or without hormonal therapy (deprives the cancer cells of male hormones, which can slow the growth of prostate cancer) compared with the other two options.

The researchers found that men who were at low-risk for having the cancer spread after undergoing treatment (as determined by a measurement called the Gleason score, which measures the progression of the cancer, equal to or below 6) had no significant differences in how they fared among the three treatment options. However, for men who were at high-risk for the spread of cancer (Gleason score of 8 to 10) did significantly better when they were treated with RP and RT than men treated with implant therapy with or without hormone therapy.

Specifically, high-risk patients who underwent implant therapy were at more than two-fold risk of having their cancer spread compared with those treated with RP, even if additional hormone therapy was used to control the disease. The researchers also found that for the intermediate-risk patients (Gleason score of 7) were at more than a three-fold increased risk compared with the RP group when treated with implant alone but fared just as well as those who had RP if hormone therapy is also administered.

Despite the preliminary nature of their findings, the authors state that their data serve to heighten awareness to the possibility that implant therapy may be effective in only a select subgroup of patients and possibly inadequate in others. They note that further prospective studies (where the outcome of the studies are measured as they happen) are needed to verify their findings.

Treatment Outcomes and Survival Rates

In a second article, researchers found that men with low-risk prostate cancer face a minimal risk of dying from the cancer within 15 years of diagnosis, but men with high-risk cancer face as much as a 60 percent to 87 percent chance of dying when treated conservatively for the disease.

Peter C. Albertsen, M.D., of the University of Connecticut Health Center in Farmington, and colleagues studied 767 men with localized prostate cancer (tumor that has not spread beyond the prostate gland) to estimate the probability of dying from prostate cancer when treated conservatively for the disease. Conservative treatment for prostate cancer is defined as either no immediate treatment or being treated with immediate or delayed hormonal therapy.

The researchers found that the chances of dying from prostate cancer increased with increases in the Gleason score: men with scores of 2 to 4 face a 4 percent to 7 percent chance of dying within 15 years of diagnosis; score of 5 faces a 6 percent to 11 percent chance of dying; score of 6 faces an 18 percent to 30 percent of dying; score of 7 faces a 42 percent to 70 percent of dying; and scores of 8 to 10 face a 60 percent to 87 percent chance of dying.

The authors note that most younger men with Gleason scores of 6 or below are still alive after 15 years; however most older men have died from competing medical conditions rather than from prostate cancer. Men with Gleason scores of 7 and 8 to 10 experienced a very high rate of death regardless of the age they were diagnosed with prostate cancer. Most of these men, except for approximately one-third of the oldest men who have died from competing medical conditions, have died from prostate cancer.

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