UroToday - AUA 2008 - The Tyrol Prostate Cancer Demonstration Project (1988 – 2007): Morbidity and Mortality

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Monday, 26 May 2008

ORLANDO, FL (UroToday.com) - Although reduction in prostate cancer mortality

rates is important, it is necessary to consider the effects of prostate cancer

screening and treatment on patient quality of life. Potential gains in survival

could be more than offset decrements in quality of life that may result from

diagnosis and treatment.

In 1988, the concept of early detection and curative radical therapy for

prostate cancer was introduced in the Tyrol. In 2005 a cumulative testing rate

of 86.6% was achieved. Overall 7439 TRUS guided biopsies were performed; before

1998 ten biopsies were performed using contrast-enhanced color Doppler

ultrasound. In men with organ-confined lesions, surgical removal of the prostate

was recommended. 89.3% of patients with T1 or T2 disease were treated with

low-morbidity radical prostatectomy, 5.7% with brachytherapy, and 4.7% with

radiotherapy. Between 1988 and 2007 2003 radical prostatectomies were performed

mostly by two surgeons (G.B., W.H.). Patients presenting with T3 lesions

underwent external beam radiotherapy.

Radical prostatectomy has been associated with low morbidity; 30-day mortality

was zero and one of the patients suffered a ureteral injury. The rectal injury

rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients

had postoperative bleeding requiring intervention. One year after surgery, 95.1%

of men were continent (no pads) and potency could be preserved in 78.9% of men

below 65 years of age. The morbidity associated with TRUS guided biopsy was low;

major complications were seen in a small percentage of patients only (0.5% of

patients with fevers higher than 100.4 degrees F requiring hospitalization).

Since 1996 a significant reduction in mortality from prostate cancer has been

observed in the Tyrol. In the years 2003 - 2005 prostate cancer mortality rates

decreased by 48%, 55%, and 52%, respectively.

The investigators conclude that these findings confirm the hypothesis that

freely available PSA testing, which has met with wide acceptance in the

population, is associated with a reduction in prostate cancer mortality in an

area where effective treatment is freely available to all men. It is likely that

much of this decline in mortality rates is due to earlier detection and

successful treatment of prostate cancer. However, an important corollary of this

study is that screening is only the first step in the optimal management of

prostate cancer.

Presented by Georg Bartsch, MD, Wolfgang Horninger, MD, Helmut Klocker, MD,

Wilhelm Oberaigner, MD, Georg Schaefer, MD, Ferdinand Frauscher, MD, Chris

on, MD, Boyle, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange County Convention Center -

Orlando, Florida, USA.

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