Reports from Dr. Catalona’s Follow-up Studies

Categories: Winter 2002

Comparing Treatments

Radical prostatectomy provides a higher 7-year PSA progression-free rate than other treatments for localized prostate cancer.

A member of Dr. Catalona’s research team in St. Louis, Julie Krygiel, reported preliminary results at the American Urological Association (AUA) on a study of 2,477 men from Dr. Catalona’s PSA Follow-up Study comparing various treatments for localized prostate cancer: radical prostatectomy, radiotherapy, hormonal therapy and observation (“watchful waiting”).

The PSA Follow-up Study was conducted on patients three or more years after they had been treated and used post-treatment PSA measurements to determine whether there was cancer progression.

The calculated 7-year progression-free rates varied greatly between treatment groups. Radical prostatectomy was the most effective with an 82% 7-year progression-free rate.

Radiotherapy, another potentially curative treatment, produced a rate of 67% and then hormone therapy, which only slows progression, had 72% progression-free rate.

The lowest progression-free rate was in patients who elected watchful waiting, with only with 35% showing no progression.

Effects of Screening on Survival

More evidence is suggesting that screening may improve outcomes of prostate cancer patients by increasing detection of organ-confined disease and decreasing prostate cancer mortality rates.

A member of Dr. Catalona’s research team in St. Louis, Kimberley Roehl, presented these results at a recent AUA conference.

Dr. Catalona treated all the patients in the study, but 443 came from a PSA screening program and 2,413 came as physician-referred patients.

The screening study recommended biopsy for PSA greater than 4 before 1995 and greater than 2.5 after 1995, or after a suspicious digital rectal exam (DRE).

Overall, the screened population had a 5% better PSA progression-free, total recurrence rate and organ-confined disease than the referred patients.

The goal of screening is to detect favorable prostate cancers – those with a Gleason score of 5-6, a low PSA, organ-confined tumor and low tumor volume – and the more favorable results of those screened were associated with lower PSA, Gleason grade and pathologic stage which occur with effective and regularly scheduled screening.

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