Research: prostate surgery not so helpful

Here's another data point for men worried about prostate cancer: surgery was no better in saving lives than observation over a 10-year period, according to one of the first rigorous studies to compare the two approaches in American men with early-stage disease.

The U.S.-funded study assigned 731 men across the country with early prostate cancer to have the gland surgically removed or be observed without any attempt at curative treatment. Ten years later, 47 percent of men in the surgery group had died, mostly from other diseases, versus 49.9 percent who were just watched, results published in the New England Journal of Medicine found. The difference wasn’t statistically meaningful.

“There is no question in my mind that what we have been doing in the United States for the last 20 years has hurt a lot of men needlessly,” said Otis Brawley, chief medical officer for the American Cancer Society. “We need to be telling men that there is tremendous evidence that a large number of men with prostate cancer could be watched and don’t need to be treated.”

In May, the U.S. Preventive Services Task Force recommended against using the prostate-specific antigen (PSA) blood test to spot the disease, saying the screening leads to overtreatment and unnecessary side effects.

Currently, only 10 percent of American men with prostate cancer who are eligible for observation choose observation, according to a National Institutes of Health report last year.

The vast majority elect surgery or various forms of radiation in an attempt to cure their cancer. Both forms of treatment have side effects, including impotence. “When men hear cancer they want something done,” said Durado Brooks, director of prostate and colorectal cancers for the cancer society. The idea that some prostate cancers aren’t life-threatening is “very difficult for people to accept because they are accustomed to thinking of cancer as this ravaging, always-lethal condition.”

After a median of 10 years, 171 of 364 men assigned surgery had died, while 183 of 367 assigned to observation died. In the surgery group, 5.8 percent of the men died from prostate cancer compared with 8.4 percent of the men in the observation group. Neither difference was statistically significant.

More than 1 in 5 patients in the surgery group had complications within 30 days of the operation. Urinary incontinence and erectile dysfunction were much more common in men who got the surgery, while men who got observation had a higher rate of developing bone metastases.

“The results are consistent with emerging science suggesting that for the vast majority of men observation can be a wise and preferred treatment choice” if they have localized prostate cancer, said Timothy Wilt, a researcher at the Center for Chronic Disease Outcomes Research at the Minneapolis Veterans Affairs Health Care System, and the study’s lead author.

Follow the link to the full article, print it out, and take it to your doctor to discuss.