Management of stage A prostate cancer with a high probability of progression

For the patient with incidentally discovered prostatic cancer that has a high probability of progression further treatment may be indicated. Several studies have shown that survival free of disease is increased by additional therapy but the choice of treatment remains unclear. The lack of matched controls has prevented rigid statistical analysis of the efficacy of prostatectomy and radiotherapy or expectant management in the treatment of these tumors. A prior review of 251 patients with stage A prostate cancer provided a population base from which to perform a matched pair analysis between 30 control patients receiving no additional treatment and 30 patients treated by either prostatectomy or radiotherapy. A second and unpaired analysis was performed among patients undergoing radical prostatectomy (17), radiotherapy (31) and expectant management alone (33). The treated group achieved a significantly superior survival free of disease over the matched control group managed expectantly. The unpaired analysis again demonstrated the advantages of treatment over no treatment but failed to define a clear statistical difference between the 2 treated groups. Radical prostatectomy appeared to provide a recognizable advantage over radiotherapy in survival free of disease but was not statistically significant owing to the small size of the sample population.