Surgery's Role in Prostate Cancer Spurs Ongoing Debate

Extract

Cancers that escape the prostate gland are usually believed to be curable, if at all, with radiation or surgery plus radiation. However, a new study suggests that, in many cases, radical prostatectomy alone can eradicate prostate cancer — even if the cancer has spread microscopically beyond the gland itself.

According to research conducted at the Johns Hopkins University in Baltimore, if cancer has spread to the periprostatic tissue (the soft tissue that surrounds the gland), the chance of cure with radical prostatectomy can still range from 7 0% to 95%. Jonathan I. Epstein, M.D., professor of pathology, urology, and oncology at Johns Hopkins, said that invasion of seminal vesicles reduces the chance of cure to 25%. In this study, published last year, 721 patients treated with surgery were followed for an average of 6.5 years.

William R. Fair, M.D., chief of urology at Memorial Sloan-Kettering Cancer Center, New York, finds some of these statistics overly optimistic. Among men who have cancer at the margin of the prostate, less than 50% will be disease-free 5 years after surgery, he said.