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Prostate Cancer Treatment, Longevity and LIfe Expectancy

Which Prostate Cancer Treatment Gives The Best Life Expectancy?

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Updated July 22, 2008

Prostate cancer treatments cover a wide range of approaches that impact life expectancy differently. Believe it or not, no formal clinical studies have been done to determine how best to treat localized prostate cancer. These studies would be extremely difficult to do -- they would take up to 10 years to complete, people would have to be randomly assigned to different treatment groups and the cost would be quite high. So instead, researchers have taken data from the past to compare treatments. This is called a retrospective (or historical) study. Keep in mind that there may be factors unknown to the researchers reviewing medical charts that impact the outcome.

Life Expectancy and Localized Prostate Cancer

Swiss researchers examined the treatment and outcomes of 844 patients diagnosed with localized prostate cancer sometime between 1989 and 1998. Five different types of treatment were applied (the "n" indicates the number of participants):
  • prostatectomy (surgical removal of the prostate) n=158
  • radiotherapy (radiation treatment) n=205
  • watchful waiting (monitoring the cancer) n=378
  • hormone therapy n=72
  • other treatments n=31

Survival and Lie Expectancy in Localized Prostate Cancer

The researchers looked at the survival rates for each group and found that at five years from diagnosis, the type of treatment made little difference to survival. When the researchers went to 10 years from diagnosis, they did find a difference in survival based on treatment. Overall, 10-year survival was:
  • 83% for prostatectomy
  • 75% for radiotherapy
  • 72% for watchful waiting
Those who had hormone risk had decreased survival rates at 5 years, but this is almost certainly because their cancer was a much more aggressive type when they were diagnosed.

Is Prostatectomy the Best Treatment for Prostate Cancer Then?

You cannot conclude that from this study. What we don't know is why certain people were given the treatment they received. It could be the Swiss doctors have a preference. For example, they might prefer a prosatectomy when the cancer presents a certain way and radiotherapy when it "looks" different. In other words, this study tells us that prostectomy is the most effective OR that doctors tend to send patients with less threatening tumors for prostectomies OR (more likely) a complex combination of both (and throw in some other factors too). Confused yet? Sorry about that. But it is important that you understand the limitations of these studies. Ask your doctor what factors he or she uses to decide on treatment and engage with that discussion.

Source:

Arnaud Merglen, MD; Franz Schmidlin, MD; Gerald Fioretta, BSc; Helena M. Verkooijen, MD, PhD; Elisabetta Rapiti, MD, MPH; Roberto Zanetti, MD; Raymond Miralbell, MD; Christine Bouchardy, MD, MPH . Short- and Long-term Mortality With Localized Prostate Cancer. Arch Intern Med. 2007;167:1944-1950.

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