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SPCG-4 trial: Update on watchful waiting versus radical prostatectomy
March 23, 2009In 2005, the Scandinavian Prostate Cancer Group Study 4 (SPCG-4) reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. At the 24th Annual EAU Congress in Stockholm, Sweden the results after 3 more years of follow-up were reported by Professor Lars Holmberg from Uppsala, Sweden.
The SPCG-4 trial - which predominantly included men whose prostate cancer was not detected by PSA screening - was the first randomized trial to show that radical prostatectomy reduces the risk of prostate cancer mortality and the risk of developing metastases.
Lars Holmberg: "Key questions following our previous analyses of this trial, which were based on a median of 8.2 years of follow-up, include whether the absolute and relative benefits of surgical treatment would increase during longer follow-up, as we hypothesized; whether overall mortality would remain reduced; whether the benefit is larger among younger than among older patients; and whether histopathologic parameters can predict lethal outcome following surgery. We think the answer may well be affirmative".
The conclusion of the study is that radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery.
Lars Holmberg: "One of the most striking results of this study was the fact that, in a follow-up of side effects, symptoms and quality of life within the randomised study, the symptom profile was different in the two randomisation groups but the overall rating of quality of life was similar. This may mean that the side effects of radical prostatectomy wear off, people get used to it perhaps." This indicates that well structured pre-treatment information, understanding of the patient's preferences and support during follow-up are central to the management of prostate cancer.
"Radical prostatectomy has changed the natural history of prostate cancer. Furthermore it is not sufficient to only to perform PSA tests in post-prostatectomy patients, we do need more tests", says Holmberg.
The SPCG-4 study continues its follow-up. The randomised patients are becoming older men by now which may again result in new and challenging data in the future.
European Association of Urology
The conclusion of the study is that radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery.
Lars Holmberg: "One of the most striking results of this study was the fact that, in a follow-up of side effects, symptoms and quality of life within the randomised study, the symptom profile was different in the two randomisation groups but the overall rating of quality of life was similar. This may mean that the side effects of radical prostatectomy wear off, people get used to it perhaps." This indicates that well structured pre-treatment information, understanding of the patient's preferences and support during follow-up are central to the management of prostate cancer.
"Radical prostatectomy has changed the natural history of prostate cancer. Furthermore it is not sufficient to only to perform PSA tests in post-prostatectomy patients, we do need more tests", says Holmberg.
The SPCG-4 study continues its follow-up. The randomised patients are becoming older men by now which may again result in new and challenging data in the future.
European Association of Urology
Prostate Cancer Current Events and Prostate Cancer News RSSDoes prostate-specific antigen velocity help in early detection prostate cancer?
The November issue of European Urology, the official journal of the European Association of Urology, features an article focussing on prostate specific antigen (PSA) velocity and early cancer detection. It has been suggested that changes in PSA over time aid prostate cancer detection.
New Synthetic Molecules Trigger Immune Response to HIV and Prostate Cancer
Researchers at Yale University have developed synthetic molecules capable of enhancing the body's immune response to HIV and HIV-infected cells, as well as to prostate cancer cells. Their findings, published online in the Journal of the American Chemical Society, could lead to novel therapeutic approaches for these diseases.
Chemo-radiation before prostate removal may prevent cancer recurrence
Researchers in the Oregon Health & Science University Knight Cancer Institute and the Portland Veterans Affairs Medical Center have found a combination of radiation therapy and chemotherapy given before prostate removal is safe and may have the potential to reduce cancer recurrence and improve patient survival.
Blood vessels might predict prostate cancer behavior
A diagnosis of prostate cancer raises the question for patients and their physicians as to how the tumor will behave. Will it grow quickly and aggressively and require continuous treatment, or slowly, allowing therapy and its risks to be safely delayed?
Short-term hormone therapy and intermediate dose radiation increases survivial for early stage prostate cancer
Short-term hormone therapy given prior to and during intermediate dose radiation treatment for men with early stage prostate cancer increases their chance of living longer, compared to those who receive the same radiation alone.
Task force develops new radiation guidelines for brachytherapy
Radiation dose delivered to the prostate and nearby organs in every brachytherapy procedure should be carefully analyzed using post-implant CT or MRI and uniformly documented in every patient.
1 disease, not 1 demographic
The Asian continent has nearly four billion people living in 47 different countries, and each of these groups has their own unique set of health issues. But when they come to the United States, they're often lumped into one large demographic: "Asian/Pacific Islander."
Cancer survivors may not be getting the help they need to stop smoking
More than a quarter of cancer survivors who still smoke have not been advised to quit smoking by their health care providers in the last year, according to a study published by researchers at Fox Chase Cancer Center in the current issue of the Journal of General Internal Medicine.
Experts issue call to reconsider screening for breast cancer and prostate cancer
Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece published in the "Journal of the American Medical Association."
Detecting the undetectable in prostate cancer screening
A team of Northwestern University researchers, using an extremely sensitive tool based on nanotechnology, has detected previously undetectable levels of prostate-specific antigen (PSA) in patients who have undergone radical prostatectomy.
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Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, Second Edition by Patrick C. Walsh (Author), Janet Farrar Worthington (Author) EVERY MAN NEEDS THIS BOOK! Each year, more than 200,00 American men are diagnosed with prostate cancer. The good news is that more men are being cured of this disease than ever before. Now in a revised second edition, this lifesaving guide by Dr. Patrick Walsh and ard-winning science writer Janet Farrar Worthington offers a message of hope to every man facing this illness. Prostate cancer is a different disease in every man--which means that the right treatment varies for each man. Giving you a second opinion from the world's top experts in surgery, pathology, urology, and radiation and medical oncology, this book helps you determine the best plan for you. Learn:What causes prostate cancer--your risk factors, including heredity, diet, and environmentHow some simple changes in your... |
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The Cleveland Clinic Guide to Prostate Cancer (Cleveland Clinic Guides) by Eric Klein (Author) Expert medical advice from one of the nation’s top-ranked hospitals for urology and cancer care
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