Surgery may suffice for some prostate cancers

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prostatectomyNEW YORK (Reuters Health) - Removal of the prostate, a procedure known as radical prostatectomy, and the surrounding lymph nodes may be adequate treatment for advanced prostate cancer, new research suggests. While adding radiation therapy may reduce the risk that the cancer will return, it does not seem to improve overall survival.

In approximately one third to one half of men treated surgically for advanced prostate cancer, some cancer remains outside the gland. How best to treat these men is a continuing subject of debate, Dr. Ian M. Thompson, Jr., and his associates point out in the Journal of the American Medical Association.

To address the issue, Dr. Thompson, at the University of Texas Health Science Center at San Antonio, and his associates initiated a trial in which adjuvant radiation therapy was compared with observation for patients with advanced prostate cancer. With this type of cancer, the disease has spread to tissues near the prostate, but has not "metastasized" to distant parts of the body.

The subjects had undergone radical prostatectomy and lymph node removal and had a negative bone scan, but were found to have cancer outside the prostate. Enrollment took place between 1988 and 1997, with follow-up until 2005.

The analysis included 214 men randomly assigned to radiation therapy and 211 who were simply observed.

During follow-up, 35.5 percent of men in the radiation group developed metastatic disease or died, compared with 43.1 percent of those in the observation-only group - which is not significantly different from a statistical standpoint. The overall survival periods in each group were similar too, at about 14 years.

On the other hand, radiation therapy was associated with a longer period until the prostate cancer returned, roughly 14 years versus 10 years in the observation group.

Complications, including rectal and urinary problems, were twice as frequent in the radiation group, the report indicates.

Based on these findings, Thompson's group suggests that an approach involving surveillance of PSA level with delayed radiotherapy if it rises "may be a reasonable alternative."

(c) Reuters 

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