Survival : Prostate cancer
By prostate Doc at 6 October, 2008, 12:53 pm
Since prostate cancer is a slow growing tumor, it is pertinent to look at survival after treatment at the 5- to 15-year period. Most data for survival appears favorable at the 5-year mark, but declines before 10 years. In general, about 70% of men treated by radical prostatectomy are cured. Approximately 20% of men will have PSA recurrence, chemical or x-ray evidence of cancer recurrence most likely within 3 years of surgery, but can take as long as 10 years.
Selective radiation therapy or systemic hormone therapy can be used in this situation. In one contemporary series the 7-year all-cause survival was 90% and the cancer-specific survival rate was 97% (Catalona). This is consistent with the Scripps Clinic cancer registry data which indicate an all-cause survival of 85-90% at 7 years following surgery. These results are higher than historical surgical data, as well as external beam radiation and conservative management. In a study by the National Cancer Institute of 59,576 patients, the 10-year sur- vival rate for prostate cancer was used as the endpoint. The results showed that for Gleason scores 2-4, the 10-year survival was 98% for those treated with surgery, 89% for radiotherapy, and 92% for those managed conservatively. For those with moderately differentiated tumors, Gleason 5-7, the rates were 91% with surgery, 74% for radiotherapy, and 76% conservative management. For aggressive tumors, Gleason grade 8-10, the results were 76%, 52%, and 43%, re- spectively. These results imply that patients with moderate to poorly differential tumors fare better with prostatectomy. Presently, more men are being diagnosed with prostate cancer at an earlier age and stage. The proportion of organ confined disease has doubled. Certainly the optimum treatment in terms of survival, freedom from disease and quality of life needs ongoing analysis.
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