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RADICAL PROSTATECTOMY IS INCREASING, DESPITE QUESTIONS ABOUT ITS VALUE.

Carcinoma of the prostate is often treated with radical prostatectomy. Two studies provide insight into the current use of this procedure and its outcomes.

The first study identified 10,598 men who underwent radical prostatectomy from a national sample of male Medicare patients aged 65 or older. The age-adjusted rate for this procedure rose 5.75-fold from 1984 to 1990, with the most marked increase among men aged 65 to 74. Rates per 100,000 patients ranged from 428.5 in Alaska to 20.4 in Rhode Island; all New England and Mid-Atlantic states had rates of 60 or less. Mortality within 30 days of surgery was 1 percent or lower for men under age 75, but rose to 4.6 percent for men over 80.

The second study used decision analysis to model and compare the effects of radical prostatectomy, external-beam radiation therapy, and watchful waiting in patients aged 60 to 75 with localized prostate cancer. The analysis suggested that radical prostatectomy and radiation therapy might benefit certain men, especially younger men with higher- grade tumors. However, early intervention offered most men little if any improvement in quality-adjusted life expectancy when compared with watchful waiting.

As an editorial points out, these data suggest that management of localized prostate cancer is based on opinion and perception as well as fact. The frequency of aggressive treatment seems to be increasing for reasons that are uncertain.

— THL

Published in Journal Watch General Medicine June 1, 1993

Citation(s):

Whitmore WF, Jr et al. Management of clinically localized prostatic cancer: an unresolved problem. JAMA 1993 May 26 269 2676-2677.

• Medline abstract (Free)

Fleming C et al. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA 1993 May 26 269 2650-2658.

• Medline abstract (Free)

Lu Yao GL et al. An assessment of radical prostatectomy: time trends, geographic variation, and outcomes. JAMA 1993 May 26 269 2633-2636.

• Medline abstract (Free)