Outcomes improving for conservative management of localized PCa

A comparison of outcomes of different eras of conservative treatment for localized prostate cancer indicates that overall and prostate cancer-specific survival rates are higher for men diagnosed from 1992 to 2002 compared with men diagnosed in the 1970s and 1980s.

Study data were published last week in JAMA (2009; 302:1202-9).

Lead author Grace L. Lu-Yao, PhD, MPH, of the Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, and colleagues analyzed data for men with localized T1 or T2 prostate cancer to evaluate the outcomes of conservatively managed localized prostate cancer diagnosed in the PSA era. The population-based cohort study included 14,516 men age 65 years or older when they were diagnosed (1992-2002) with stage T1 or T2 prostate cancer and whose cases were managed without surgery or radiation for 6 months after diagnosis. The men were followed for a median of 8.3 years.

The researchers found that 10-year prostate cancer-specific mortality was 8.3% for men with well-differentiated tumors, 9.1% for those with moderately differentiated tumors, and 25.6% for those with poorly differentiated tumors. The corresponding 10-year risks of dying of causes other than prostate cancer were 59.8%, 57.2%, and 56.5% for each respective group.Ten-year disease-specific mortality for men age 66 to 74 years diagnosed with moderately differentiated disease was 60% to 74% lower than earlier studies.

"Survival results in our contemporary PSA era study cohort were more favorable than results previously reported," the authors wrote. "For example, in the current study, 10-year prostate cancer-specific mortality was 6% in the contemporary PSA era (1992-2002) compared with results of previous studies (15% to 23%) in earlier eras (1949-1992) for men aged 65 to 74 years diagnosed with moderately differentiated disease.

"Improvement in survival among men with older age or poorly differentiated disease was also observed."