Quest Summer 2014 : Page 1

This issue of Q UEST is sponsored by A Publication of Dr. William J. Catalona Radical Prostatectomy vs. Watchful Waiting Q uest Summer / Fall 2014 • Volume 22, Number 2 and the Urological Research Foundation ©Jan Catalona Long-Term Scandinavian Study Favors Surgery N T as hormone therapy, radiation or ew research published in the chemotherapy. New England Journal of Medicine demonstrates that Men Under 65 early diagnosis and treatment of The study found that men prostate cancer reduces suffering and younger than 65 who had a death in men younger than 65 years radical prostatectomy had a 15.8% and the rate of metastatic cancer in lower risk of dying from prostate older men. The cancer than men findings come from The goals of radical prostatectomy who did not The Scandinavian have surgery. are to prevent suffering and death Prostate Cancer These men also from prostate cancer. This study Group Study had a 15.8% provides new level-1 evidence that lower risk of the Number 4 (SPCG-4), a 23-year study in low-risk patients, surgery cancer spreading funded by the to other organs significantly reduces suffering in Swedish Cancer and a 25.5% those men who are otherwise Society and the U.S. lower risk of healthy and have a long life National Institutes overall mortality. expectancy. –Dr. William J. Catalona of Health. Men in this Between 1989 group were also and 1999, researchers randomly less likely to need palliative assigned 695 men with prostate cancer treatment. Looking ahead can provide insight for today. to either watchful waiting or radical Men 65 and Older prostatectomy. The men had been suffering from advanced disease. The There was only a 1.9% reduction in diagnosed with localized prostate researchers wrote that “the overall overall mortality for men 65 years and cancer before the era of PSA testing. long-term disease burden is also a older assigned to the radical Researchers followed the men through reminder that factors other than prostatectomy group, and a 6.6% the end of 2012 to observe the survival should be considered when reduced risk of death from prostate prevalence of death from prostate counseling men with localized prostate cancer. However, the risk of metastases cancer or other causes, metastatic cancer; the risk of metastases and was reduced by 8.9% among men in cancer and palliative treatments such ensuing palliative treatments also affect this group compared to men in quality of life.” the watchful waiting group. he mission of Q UEST is to educate the See page 2 for further comments on This is the first study to this study from Dr. Catalona. public about the prevention, detection demonstrate that a radical Bill-Axelson, A. et al. Radical prostatectomy could reduce and treatment of prostate cancer. Please Prostatectomy or Watchful Waiting in Early metastatic prostate cancer in support the URF in this effort. Prostate Cancer. NEJM. 2014; 370(10);932-42 older men, and thus prevent

Long-Term Scandinavian Study Favors Surgery

Dr. William J. Catalona


New research published in the New England Journal of Medicine demonstrates that early diagnosis and treatment of prostate cancer reduces suffering and death in men younger than 65 years and the rate of metastatic cancer in older men. The findings come from The Scandinavian Prostate Cancer Group Study Number 4 (SPCG- 4), a 23-year study funded by the Swedish Cancer Society and the U.S. National Institutes of Health.

Between 1989 and 1999, researchers randomly assigned 695 men with prostate cancer to either watchful waiting or radical prostatectomy. The men had been diagnosed with localized prostate cancer before the era of PSA testing. Researchers followed the men through the end of 2012 to observe the prevalence of death from prostate cancer or other causes, metastatic cancer and palliative treatments such as hormone therapy, radiation or chemotherapy.

Men Under 65

The study found that men younger than 65 who had a radical prostatectomy had a 15.8% lower risk of dying from prostate cancer than men who did not have surgery. These men also had a 15.8% lower risk of the cancer spreading to other organs and a 25.5% lower risk of overall mortality. Men in this group were also less likely to need palliative treatment.

Men 65 and Older

There was only a 1.9% reduction in overall mortality for men 65 years and older assigned to the radical prostatectomy group, and a 6.6% reduced risk of death from prostate cancer. However, the risk of metastases was reduced by 8.9% among men in this group compared to men in the watchful waiting group.

This is the first study to demonstrate that a radical prostatectomy could reduce metastatic prostate cancer in older men, and thus prevent suffering from advanced disease. The researchers wrote that “the overall long-term disease burden is also a reminder that factors other than survival should be considered when counseling men with localized prostate cancer; the risk of metastases and ensuing palliative treatments also affect quality of life.”

See page 2 for further comments on this study from Dr. Catalona.

Bill-Axelson, A. et al. Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer. NEJM. 2014; 370(10);932-42

The mission of QUEST is to educate the public about the prevention, detection and treatment of prostate cancer. Please support the URF in this effort.

Read the full article at http://epubs.democratprinting.com/article/Long-Term+Scandinavian+Study+Favors+Surgery/1785021/221278/article.html.

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