Ben Kazie MD

This study’s authors conclude: “Few patients will die from prostate cancer within 15 years of radical prostatectomy, despite the presence of adverse clinical features. This favorable prognosis may be related to the effectiveness of radical prostatectomy (with or without secondary therapy) or the low lethality of screen-detected cancers. Given the limited ability to identify contemporary patients at substantially elevated risk of PCSM on the basis of clinical features alone, the need for novel markers specifically associated with the biology of lethal prostate cancer is evident.”

Having said the above, the fact remains that prostate cancer kills almost 30,000 men each year. It is also true that we are getting better at making more educated guesses regarding which men are most at risk to progress with prostate cancer.  Finally, it has long been true that radical prostatectomy has been felt to be superior to all other forms of treatment in terms of achieving a long term cure of prostate cancer (this would include all forms of radiation, cryotherapy, HIFU and other new novel technologies).  Which his not to say that other forms of therapy are not successful and adequate for most men as well.  The key to successful treatment of any cancer is early detection and then eradication of the cancer.

At the present time, all one can take from this study and the data available, is that men diagnosed with prostate cancer, after considering all options of treatment, all of which are approved and in fact good, should strongly consider surgery assuming they are medical fit to undergo surgery.  They must of course also be mentally and emotionally able to undergo the rigors of a surgical approach.  Today, however, with the use of laparoscopic approaches and robotics assistance, many radical prostatectomies are accomplished with little or no morbidity and almost zero mortality.  As this study points out, we still lack the test to compliment PSA, one that will tell us which men are most likely to actually die from prostate cancer itself.  That test will be of great assistance in making the early detection available by use of PSA more meaningful . . . ben kazie md

Men have a low risk of dying from prostate cancer 15 years after radical prostatectomy, suggesting that at least some did not require surgery, a large multicenter review suggests. The study showed that most men who undergo surgery for prostate cancer are unlikely to die of prostate cancer. The findings were based on a retrospective review of medical records. The 15-year prostate cancer-specific mortality was 12% after radical prostatectomy, including 5% in men with low-risk features. The favorable prognosis might reflect the effectiveness of radical prostatectomy or, alternatively, the indolent nature of many screen-detected prostate cancers, investigators reported online in the Journal of Clinical Oncology

Radical prostatectomy effective against cancer, study at Cleveland Clinic, other sites finds – http://www.cleveland.com/healthfit/index.ssf/2009/07/radical_prostatectomy_effectiv.html

Men Who Have Prostate Cancer Surgery Do Well – http://healthday.com/Article.asp?AID=629386

Prostate Cancer–Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era – http://jco.ascopubs.org/cgi/content/abstract/JCO.2008.18.2501v1

Prostate Cancer Death Unlikely After Prostatectomy – http://www.medpagetoday.com/Oncology/ProstateCancer/15274

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