Non-Surgical Approach to Low-Grade Prostate Cancer Does Not Affect Life Span

Life span is decreased without surgery for high-grade prostate cancer patients.

Men aged 65-75, treated conservatively for low-grade localized prostate cancer, probably will not die any sooner than similar members of the general population; however, men diagnosed with high-grade tumors often have a 6-8 year loss of life expectancy when treated with conservative therapy, according to an article in a recent issue of The Journal of the American Medical Association.

Peter C. Albertsen, M.D., from the University of Connecticut Health Center in Farmington, and colleagues examined the medical histories of 451 men diagnosed with clinically localized prostate cancer between 1971-1976 as listed by the Connecticut Tumor Registry. The men were all aged 65-75 years at the time of diagnosis. Conservative therapy consisted of immediate hormonal treatment for 202 men and no treatment for the first three months for the remaining 249 men.

After a follow-up averaging 15.5 years, the researchers found that 411 men (91 percent) had died and 40 (nine percent) were alive at last contact. Of the 411 who had died, 154 died of prostate cancer, 221 had other causes listed on the death certificate, and 36 had unknown causes of death.

The authors write: "Forty-six percent of men diagnosed as having high-grade prostate cancer had died of their disease within 10 years, and 51 percent had died within 15 years; the corresponding percentages for men with moderate-grade disease, were 24 percent and 28 percent respectively. Men with low-grade prostate cancer demonstrated no prostate cancer mortality before seven-years of follow-up. Their 10- and 15-year cumulative mortality from prostate cancer was nine percent."

The researchers say the most powerful predictor of survival was the size of the tumor at diagnosis: "Men aged 65-75 years diagnosed as having low-grade prostate cancer face no apparent loss in life expectancy compared with a relevant general population ... (Therefore), our findings suggest that more aggressive treatment is unwarranted."

They continue: "Men with moderate-grade and high-grade tumors face a progressively greater loss of life expectancy compared with the general population. We estimate that for men aged 65-75 years at the time of diagnosis, this loss of life is probably no greater than 4-5 years for moderate-grade tumors and 6-8 years for high-grade tumors. Because the goal of aggressive treatments, such as radical surgery or radiation therapy, is to cure affected men, our data provide quantitative upper-bound estimates of the potential years of life to be saved. Whether aggressive treatment is able to achieve these potential savings can be judged only by prospective randomized trials."

This study is believed to be the first population-based survival analysis of conservatively treated prostate cancer in the United States, according to the authors.

Source: American Medical Association
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