Patients who refuse prostate cancer surgery have worse long-term survival

DETROIT, June 2010 – Men who refuse surgery for prostate cancer and instead opt for "watchful waiting" – monitoring cancer progression without undergoing treatment – have a significantly worse long-term survival rate than those patients that choose radiotherapy, according to researchers at Henry Ford Hospital in Detroit.

The study found that patients who refused any treatment for their prostate cancer had a 10-year overall survival rate of 51 percent, compared to 68 percent for those who chose radiation treatment.

"Surgery has been shown to offer a survival advantage to patients with prostate cancer when compared with other treatment options.

"However, a significant number of patients refuse surgery and instead opt for other treatments such as radiotherapy" says study lead author Naveen Pokala, M.D., an urologist at Henry Ford Hospital.

The study was presented at the 2010 American Urology Association's annual meeting in San Francisco.

These findings follow a study published by Dr. Pokala in 2009 that showed surgery improves 5-, 10- and 15-year survival rates for men younger than 50 with moderately and especially in poorly differentiated prostate cancers, when compared with other standard treatments such as radiation therapy or watchful waiting.

The new research, a population-based analysis of 9,704 patients chosen from the National SEER database, looked at survival rates among men with a mean age of 64.4 years, of whom 77 percent were white and 16.4 percent black.

Of that group, nearly 30 percent refused any treatment for their prostate cancers, and about 70 percent chose radiation therapy.

Within the group, 6 percent had well-differentiated cancers, 75 percent moderately differentiated cancers, and 18 percent had poorly differentiated cancer.

More than 70 percent of the patients were unmarried. In all, African American men older than 65 had the worst prognosis.

Prostate cancer is second only to skin cancer as the most common cancer in American men, affecting one in six during his lifetime. The majority of the cases are in men older than 65, but it is becoming more prevalent in men under 40.

It affects black men twice as often as whites, and their mortality rate is also twice as high.

While curable in its early stages, symptoms often don't appear until the cancer has spread beyond the prostate gland itself, so annual exams for the disease are recommended.

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In addition to Dr. Pokala, study co-authors at Henry Ford Hospital included James Peabody, M.D., and Mani Menon, M.D.