Radical Prostatectomy versus Observation for Localized Prostate Cancer

July 31st, 2012

SUMMARY: In this study, 731 men with localized prostate cancer, diagnosed based on PSA testing, were randomly assigned to Radical Prostatectomy (RP) or Observation. The median age was 67 years, median PSA was 7.8ng/ml and median follow up was 10 years. This study concluded that RP did not significantly reduce all cause mortality or mortality related to prostate cancer. However on subset analysis, RP slightly decreased mortality among men with PSA greater than 10ng/ml and among those with intermediate and high D’Amico tumor risk score. As only 10% of the patients were less than 60 years of age, these data may not be applicable to this patient subset. Based on this study, it may be reasonable to avoid RP for those prostate cancer patients with PSA levels of 10ng/ml or less and for those with low risk tumors. Wilt TJ, Brawer MK, Jones KM, et al., for the Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group. N Engl J Med 2012; 367:203-213

Adjuvant Therapy in the Treatment of Biliary Tract Cancer A Systematic Review and Meta-AnalysisAdjuvant Therapy in the Treatment of Biliary Tract Cancer A Systematic Review and Meta-Analysis

July 23rd, 2012

SUMMARY: The authors in this meta-analysis reviewed data on 6712 patients with biliary tract cancers, including gall bladder tumors. Ampullary tumors were excluded. These patients had resections done with a curative intent and this was defined as those with negative surgical margins (R0) or microscopic positive margins (R1). All these patients received adjuvant therapy, which included chemotherapy, radiation therapy or a combination of both, following surgery. There was an improvement in overall survival for those patients receiving adjuvant therapy. Patients who received chemotherapy or chemoradiation treatment derived greater benefit than those who received radiation therapy alone. The greatest statistically significant benefit was seen in those with lymph node positive disease and R1 disease. Based on this analysis, it may be reasonable to consider adjuvant therapy for patients with high risk biliary tract cancers. Horgan AM, Amir E, Walter T, et al. JCO  2012; 30:1934-1940