Life expectancy doubled for advanced prostate cancer patients

After being diagnosed with aggressive prostate cancer, many men are told that their disease is untreatable and that less aggressive treatment is best.

Often this means patients are told to watch and wait -- that is, to do nothing at all. A new study by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center turns conventional wisdom on its head, finding either surgical removal of the prostate (prostatectomy) or radiation treatment more than doubles the life expectancy for these patients when compared with those receiving the conservative approach.

Patients with the most aggressive non-metastatic prostate cancers (Gleason scores 8–10), if treated with prostatectomy or radiation, can expect to live more than 14 years; those treated conservatively will live, on average, less than 7 years. The study appears in the March Journal of Urology.

"Unfortunately, pessimism abounds among many doctors, who believe that aggressive prostate cancers are beyond cure and should only be followed with watchful waiting, forestalling any immediate treatment. This new study points to the fallacy of this outlook, finding surgery and radiation more than double the life expectancy for these patients," says Dr. Ashutosh Tewari, the study's first author and director of robotic prostatectomy and urologic oncology outcomes at NewYork-Presbyterian/Weill Cornell and the Ronald P. Lynch Associate Professor of Urologic Oncology at Weill Cornell Medical College.

The study involved a retrospective statistical analysis of outcomes of 453 cases of clinically localized aggressive prostate (graded Gleason scores 8–10) at the Henry Ford Health System in Detroit.

"Ultimately, randomized clinical trials studying long-term outcomes will be necessary to fully demonstrate the benefits of treatment for these patients," adds Dr. David Nanus, a study co-author and medical director of the Genitourinary Oncology Program at NewYork-Presbyterian/Weill Cornell. He is co-division chief of hematology and medical oncology and the Mark W. Pasmantier Professor of Hematology and Oncology in Medicine at Weill Cornell Medical College.

The study's senior author is Dr. Mani Menon of the Henry Ford Health System in Detroit.

In 2006, roughly 234,000 American men were diagnosed with prostate cancer. The most aggressive prostate cancers often result in early metastasis and death. Left untreated, as many as 85 percent of men die from prostate cancer within 10 years of diagnosis. High-grade cancers are also unique because they can affect younger men and have a relative resistance to radiation.