Compared with conservative 'watchful waiting', radiation therapy or radical prostatectomy can lead to a significant improvement in survival for men with high-grade prostate cancer, New York-based researchers report. Compared with conservative 'watchful waiting', which is often recommended for men with high-grade prostate cancer because of the difficulty of treating it, radiation therapy or radical prostatectomy can lead to a significant improvement in survival, New York-based researchers report.

"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," lead investigator Dr. Ashutosh Tewari told Reuters Health. "Those treated conservatively will live, on average, less than 7 years."

Dr. Tewari and associates at New York Presbyterian Hospital, Weill Medical College of Cornell University conducted a retrospective study of 453 prostate cancer patients with a Gleason score of 8 or higher. The findings are reported in the March issue of the Journal of Urology.

Of this group, 197 (44 per cent) were treated conservatively, 137 (30 per cent) received radiation therapy and 119 (26 per cent) underwent radical prostatectomy. Corresponding median overall survival times were 5.2, 6.7 and 9.7 years.

Median cancer-specific survival was 7.8 years for conservative therapy and more than 14 years for radiation therapy and radical prostatectomy. "The risk of cancer-specific death following radical prostatectomy was 68 per cent lower than for conservative treatment and 49 per cent lower than for radiation therapy," Dr. Tewari's group found.

The researchers conclude that "even high-grade cancers are potentially curable. Retrospectively, there is a significant difference in long-term outcome among patients undergoing conservative treatment, radiation therapy and radical prostatectomy."

J Urol 2007;177:911-915.