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Surgery
improves survival for prostate cancer
patients younger than 50
For men younger than 50 with prostate
cancer, undergoing a radical prostatectomy
can greatly increase their chances for
long-term survival, according to a new study
from Henry Ford Hospital.
Results from the study done on the National
SEER database show that the surgical
procedure improves the 5-, 10-, 15- and
20-year survival for younger patients, when
compared with other standard treatments such
as radiotherapy or watchful waiting.
"When given the choice between surgery,
watchful waiting or external beam
radiotherapy, patients younger than 50 with
moderately and poorly differentiated
prostate cancers have better long-term
overall and cancer-specific survival when
they opt for surgery," says study author
Naveen Pokala, M.D., an urologist with Henry
Ford Hospital.
Based on findings from the study, Dr. Pokala
and co-author Mani Menon, M.D., director of
Henry Ford's Vattikuti Urology Institute,
strongly recommend retropubic radical
prostatectomy – a surgical procedure that
removes the entire prostate gland plus some
of the tissue around it – as the treatment
of choice for prostate cancer patients under
the age of 50.
Prostate cancer affects one in six men in
the United States during his lifetime, but
according to the American Cancer Society
only one in 35 will die of it.
Although the majority of all prostate cancer
are diagnosed in men older than 65, its
prevalence is growing among men younger than
50.
In fact, about one in 10,000 men under the
age of 40 will be diagnosed this year with
prostate cancer.
To determine which treatment option offers
the best chance for long-term survival for
younger prostate cancer patients, Pokala and
Menon studied more than 8,200 men under age
50 with prostate cancer.
Among the study group, 73 percent were white
and about 22 percent were black. The mean
age was 46, and over 70 percent had
moderately and 22 percent had poorly
differentiated cancers.
Of the patients, 1,065 were managed with no
definitive treatment (watchful waiting);
6,614 (79.9 percent) with radical retropubic
prostatectomy; and 600 with external beam
radiotherapy.
The cancer-specific survival in the NDT
group was 78 percent at 16 years, in the
radiation group was 63 percent at 17 years;
and 94 percent in the radical prostatectomy
at 21 years.
On a subset analysis the outcome was
significantly better after radical
prostatectomy in patients with moderately
and poorly differentiated prostate cancer.
Overall, the study shows the 5-year,
10-year, 15-year and 20-year overall
survival and cancer specific survival is
significantly increased in patients who were
less than 50 years of age with moderately
and poorly differentiated cancers in the
surgery group.
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