A study co-led by researchers at King’s College London shows that the percentage of men who had a radical prostatectomy (removal of the prostate and surrounding cancer cells) and survived for 15 years is higher than men who were only given treatment at signs of further progression of prostate cancer, an approach known as ‘watchful waiting.
Scientists say that this represents clear evidence that operations remain a very effective treatment for prostate cancer. The next question to answer is whether operations are more effective than ‘active surveillance’ – an approach now commonly used to monitor the disease very carefully and deliver curative treatment at the first sign of progression. This is a more active approach than watchful waiting.
This study, published in the New England Journal of Medicine, is a 15 year follow-up to a study which looked at 695 men diagnosed with early prostate cancer between 1989 and 1999. Half of the participants were assigned to radical prostatectomy and the other group treated with a watchful waiting approach.
Findings show that over the last 15 years 55 of the 347 men assigned to surgery (14.6 percent) and 80 of the 348 men assigned to watchful waiting (20.7 percent) died as a result of prostate cancer. This shows the operative approach is more favourable for long-term survival.
A reduction in mortality was also seen among men deemed at diagnosis to have a low risk prostate cancer. This is important new information as previously there was a fear that operation would have very little effect on prostate cancer detected very early.
In addition, among the patients who underwent radical prostatectomy, those who were found to have microscopic tumour growth beyond the prostate capsule had seven times the risk of death from prostate cancer compared to those without. This finding is of significance, as this highlights a group of patients for whom treatments such as postoperative radiotherapy or hormonal treatment in addition to an operation would be beneficial.
Professor Lars Holmberg, from the Division of Cancer Studies at King’s, said: ‘Our study shows that long term follow-up of carefully designed clinical studies in prostate cancer continue to add new, important information which can impact on the way patients are treated, and ultimately lead to better survival rates.
‘We now have indications that the effects of an operation also extends to a group of men deemed to have low risk disease at diagnosis, and that the effect of the operation continues for ten years or more.
‘These findings highlight how important these follow-up studies are in terms of ensuring patients are offered a high standard of care, appropriate to their needs, based on evidence.
King’s College London
King’s College London is one of the top 25 universities in the world (2010 QS international world rankings), The Sunday Times ‘University of the Year 2010/11’ and the fourth oldest in England. A research-led university based in the heart of London, King’s has nearly 23,500 students (of whom more than 9,000 are graduate students) from nearly 140 countries, and some 6,000 employees. King’s is in the second phase of a £1 billion redevelopment programme which is transforming its estate.
King’s has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.
King’s has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.
King’s College London and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts are part of King’s Health Partners. King’s Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world’s leading research-led universities and three of London’s most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: