Objectives: To report the long-term survival probability in more than 3000 men with localized prostate cancer treated either conservatively or by definitive treatment (radiotherapy or radical prostatectomy). Methods: We studied 3159 men with biopsy-confirmed, clinically localized prostate cancer diagnosed from 1980 to 1997. We restricted our analysis to men 75 years of age or younger. The extent of comorbid disease was measured using the Charlson score. The Cox proportional hazards regression model was used to compare long-term survival in patients who were treated conservatively versus survival in patients treated with either radiotherapy or radical prostatectomy. Results: After adjusting for age, race, tumor grade, comorbid disease, income status, and year of diagnosis, the overall survival rate at 15 years was 35% for conservative management, 50% for radiotherapy, and 65% for radical prostatectomy. The corresponding prostate cancer-specific survival rates were 79%, 87%, and 92%. Patients undergoing radiotherapy or radical prostatectomy had lower overall mortality than patients undergoing conservative management (adjusted relative risk 0.67 for radiotherapy and 0.41 for prostatectomy; P <0.001). The increase in the survival duration was 4.6 years with radiotherapy and 8.6 years with radical prostatectomy. Conclusions: The results of this study have shown that compared with conservative management, both radiotherapy and radical prostatectomy increase survival for men with localized prostate cancer.
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