A new study suggests that surgery for prostate cancer could save lives and lead to a better quality of life.
The paper, published in the New England Journal of Medicine, is an update on a study previously launched in Finland, Iceland and Sweden. For the study, almost 700 men newly diagnosed with prostate cancer were split into two groups. Half had their prostate gland fully removed and half were tracked through a process of "watchful waiting," in which doctors only treated them if symptoms progressed.
The study showed that, on average, those who underwent surgery lived longer, had fewer complications from the disease and were less likely to see the cancer spread. The benefit was greatest for men in their 50s and early 60s.
Watchful waiting is a frequently used practice because of the side effects of surgery and because most prostate cancers grow so slowly that patients will die due to other causes before dying of the cancer.
"Our research suggests that we overtreat many men," said Dr. Peter Carroll, chairman of urology at the University of California, San Francisco. "But at the same time, we may undertreat those with high-risk cancers."
The study's authors urge caution in interpretation of the study, saying they aren't looking to rule out current guidelines that recommend watchful waiting.
According to Dr. Otis Brawley, medical director of the American Cancer Society, only 12 percent of U.S. prostate cancer patients are found due to showing symptoms. The others are identified by PSA tests and other screenings.
"Those guys with high-grade tumors, those are the guys we ought to be treating," Brawley said.
He noted that other studies have found even less benefits from surgery.
"They all say the same thing, that radical prostatectomy for men 65 and above seems not to save lives," he said.
Others, however, are impressed by the finding that all of the study's groups had fewer side effects after initially opting for surgery. Surgery often has side effects that can include sexual dysfunction and/or urinary incontinence. But an alternative, long-term hormone therapy, has its own potential side effects including hot flashes, low sex drive, weight gain, loss of energy and an increased risk of heart disease.
Carroll said the new study emphasizes the need to differentiate between high- and low-risk cancers.
"Although it is often said that there is little benefit (from surgery) to those over 65, this appears not to be the case," he said. "It's more a function of the aggressiveness of the tumor and the health of the patient."
