Older Men with Early Stage Prostate Cancer Survived Longer with Either Surgery or Radiation Therapy Compared to Observation
Study examines data of more than 48,000 men between age 65 and 80 and is the first known study in an older population to show survival benefit with radiation therapy.
PHILADELPHIA - A new study shows older men with early stage prostate cancer survive longer if they are treated versus not being treated in favor of the "watchful waiting" approach advocated by many physicians for older men with other health problems. In addition, the study revealed a survival benefit for men treated with radiation therapy making it the first study to demonstrate a survival advantage in an older population. The study was presented by Fox Chase Cancer Center medical oncologist Yu-Ning Wong, MD, at the 2006 Prostate Cancer Symposium Feb. 25 in San Francisco.
The study examines survival data of more than 48,606 men between 65 and 80 years old who survived at least one year after a diagnosis of localized prostate cancer (cancer that has not spread beyond the prostate).
Since the advent of the PSA (prostate-specific antigen) blood test about 20 years ago, many more cases of prostate cancer have been diagnosed at earlier stages.
"Some prostate cancers grow so slowly that they never become life-threatening, especially in elderly men who may die of other causes before the cancer causes problems," explained Wong. "But other men develop complications and die from their cancer making the decision to treat quite difficult."
It remains unclear whether detecting early prostate tumors translates into an equivalent benefit of saving lives and whether the benefits of early detection outweigh the risks of complications from follow up diagnostic tests and cancer treatments.
The cases examined in this study were diagnosed between 1991 and 1999. The men ranged from 65 to 80 years old at diagnosis. Median age at diagnosis was 72. A total of 34,046 men received treatment with either radiation therapy (19,948) or surgery-radical prostatectomy-to remove the prostate (14,098). The remaining 14,560 men were only observed (watchful waiting).
More than half the treated men were alive by the end of the study, with a median survival of 13 years. Median survival for the group receiving observation was about 10 years.
"This large, population-based study demonstrates a survival advantage for men treated with either radical prostatectomy or radiation therapy compared to observation," Wong said. "Eligible men should be considered for both treatment options."
The study used national Surveillance, Epidemiology and End Results (SEER)-Medicare database. Interpretation and reporting of these data are the sole responsibility of the authors. They gratefully acknowledge the efforts of the National Cancer Institute's Applied Research Program, the Centers for Medicare and Medicaid Services' (CMS) Office of Research, Development and Information, Information Management Services, Inc., and the SEER Program tumor registries in creating the SEER-Medicare database.
The American Society of Clinical Oncology (ASCO), the American Society for Therapeutic Radiology and Oncology (ASTRO), the Prostate Cancer Foundation (PCF) and the Society of Urologic Oncology (SUO) sponsored the 2006 Prostate Cancer Symposium.
Wong's co-authors include Fox Chase medical oncologist Gary R. Hudes, MD, and Fei Wan, Chantal Montagnet, Russell Localio, PhD, and Katrina Armstrong, MD, all of the University of Pennsylvania. This research was sponsored by the Center for Population Health and Health Disparities at the University of Pennsylvania under Public Health Services Grant P50-CA105641.
Notes to editors:
- This observational study supports the findings of a Scandinavian study reported in 2005 comparing patients who had a radical prostatectomy to those only observed. It found a survival advantage after 8.2 years of follow-up for those treated with a prostatectomy. (Axelson, et. al., NEJM, May 12, 2005).
- Because medical opinion is divided on the true value of prostate cancer screening for men at average risk, the National Cancer Institute is conducting a large study to see if yearly screening with a digital rectal exam (DRE) and PSA blood test decreases prostate cancer deaths. Full results from this Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) are expected in several years. Scientists are also seeking ways to distinguish between slow-growing prostate cancers and fast-growing, potentially fatal tumors.
Fox Chase Cancer Center, part of Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase also was among the first institutions to receive the National Cancer Institute’s prestigious comprehensive cancer center designation in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are routinely recognized in national rankings, and the Center’s nursing program has achieved Magnet status for excellence three consecutive times. Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research and oversees programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX-CHASE (1-888-369-2427).