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Advantages of Surgical Therapy for
Prostate Cancer
Michael S. McGuire MD
Chief, Division of Urology
Co-Director, Prostate Cancer Center
NorthShore University HealthSystem
Significance of Prostate Cancer
• Man diagnosed with prostate cancer every 3
minutes
• Man dies of prostate cancer every 20
minutes
• 17% lifetime risk of being diagnosed with
prostate cancer
• 3% risk of dying of prostate cancer
Prostate Biopsy
• Each Biopsy=0.009 cc
• Typically 12 biopsies
• Total volume
removed=0.108 cc
• Mean Prostate Volume
Biopsied= 30cc
• Total % Sampled=
0.36%
Results of Small Biopsy Sample
• Cancer Volume
– Hong et al. JUrology April 2009:55
» Patients with small volume, unilateral disease on biopsy
underwent prostatectomy
» 34/104 patients (32%) unilateral disease at
prostatectomy
– Nepple et al. JUrology April 2008:639
» Patients with small volume, unilateral disease on biopsy
underwent prostatectomy
» 18/90 (20%) unilateral disease at prostatectomy
Results of Small Biopsy Sample
• Cancer Grade
– Pinthus et al. JUrology Sept 2006:979
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Compared Biopsy and Prostatectomy Gleason Score
Biopsy Gl 6-> Prostatectomy Gleason 6 (38.2%)
Biopsy Gl 7-> Prostatectomy Gleason 7 (81.2%)
Patients upgraded Gleason score had increased positive
margin, seminal vesicle involvement, cancer volume,
and psa failure
Advantages of Surgery
• Much More Valid Prognostic Information
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True Tumor Grade
Tumor Volume
Margin Status
Node Status
Advantages of Surgery:
Cure
• Bill-Axelson et al. NEJM 2005;352:1977
– 695 early-staged men randomly assigned to
Watchful Waiting v. Prostatectomy
» 8 yr f/u
» Deaths due to Prostate Cancer
– WW 31/348 8.9%
– RRP 16/347 4.6%
P=0.02
Advantages of Surgery:
Cure
• Bill-Axelson et al. NEJM 2005;352:1977
– Deaths Not from Prostate Cancer
» WW 31/348 (8.9%)
» RRP 37/347 (10.6%)
Advantages of Surgery:
Cure
• Bill-Axelson et al. NEJM 2005;352:1977
– First Gold- Standard Study to show an advantage
for treatment
– Authors suggest must treat 17 patients to prevent
one patient death
PROSTATE CANCER TREATMENT:
WHAT’S BEST FOR YOU
PROSTATE CANCER SYMPOSIUM
NORTHWESTERN UNIVERSITY
FEINBERG SCHOOL OF MEDICINE
SEPTEMBER 11, 2010