© 2005 Oxford University Press
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In Brief
Radical Prostatectomy Reduces Prostate Cancer, Overall Mortality, Study Finds
Men with early prostate cancer who are treated with radical prostatectomy have a lower risk of death from prostate cancer and a lower risk of dying from any cause than men treated with watchful waiting, according to a new study.
A group of Swedish researchers, led by Anna Bill-Axelson, M.D., and Lars Holmberg, M.D., Ph.D., from University Hospital, Uppsala, conducted a clinical trial in which 695 men with early prostate cancer were randomly assigned to either a radical prostatectomy or watchful waiting. In 2002, the researchers reported that, after a mean follow-up of 6.2 years, radical prostatectomy reduced the risk of death due to prostate cancer by 50% (8.9% in the control group compared with 4.6% in the surgery group). However, there was no statistically significant reduction in overall mortality.
In the May 12 issue of the New England Journal of Medicine, the group reported results after a median follow-up of 8.2 years. During this time, 83 men in the surgery group died, including 30 (8.5%) from prostate cancer, compared with 106 men in the watchful-waiting group, including 50 (14.4%) from prostate cancer. There was a 10-year absolute benefit in overall mortality of 5% among men who had a radical prostatectomy.
Substantial Reduction in Recurrence, Mortality Found for Adjuvant Treatments for Breast Cancer
Several of the adjuvant chemotherapies and hormonal therapies commonly used to treat early breast cancer have a much greater mortality benefit after 15 years than after 5 years, and this may be one reason for the decrease in breast cancer mortality in many countries including the United States, according to a new study.
In early breast cancer, adjuvant chemotherapy and hormonal therapy are used after surgery to treat potentially undetected disease that could develop into a clinical recurrence over time. Because the many randomized trials that have examined the various treatments for breast cancer have had different lengths of follow-up, the Early Breast Cancer Trialists' Collaborative Group was set up in the mid-1980s to coordinate every 5 years worldwide meta-analyses of centrally collected follow-up data from the women who participated in these trials. In the May 14 issue of The Lancet, the group published a meta-analysis of 194 trials of adjuvant systemic therapy that had included approximately 145,000 women with long-term follow-up.
Among the findings were that 6 months of an adjuvant anthracycline-based regimen reduced the annual rate of death from breast cancer by 38% among women younger than age 50 and by 20% in women ages 50–69. For women with estrogen receptor (ER)–positive disease, 5 years of adjuvant treatment with tamoxifen reduced the annual rate of death from breast cancer by 31% and was more effective than 1–2 years of tamoxifen. The group estimated that for middle-age women with ER-positive breast cancer, the rate of death from breast cancer would be halved in 15 years through the use of anthracycline-based chemotherapy followed by 5 years of tamoxifen. However, further improvements could be made in long-term survival through the use of newer treatment regimens or better use of old ones, they conclude.
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