Study: Surgery Best for Prostate Cancer

But experts say this decision is best made by patient and his doctor

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HealthDay Reporter

WEDNESDAY, May 11, 2005 (HealthDay News) -- Men with early prostate cancer often face a dizzying array of treatment options, but a new study finds a surgical procedure called radical prostatectomy increases the odds of surviving prostate cancer and reducing the chances the cancer will spread.

That's the conclusion of a new Swedish study in the May 12 issue of the New England Journal of Medicine.

"Radical prostatectomy reduces mortality in prostate cancer and also the risk of metastases, which becomes apparent after 10 years," said study author Dr. Anna Bill-Axelson, a urologist at University Hospital in Uppsala.

In radical prostatectomy, surgeons remove the prostate, as well as surrounding tissue and lymph nodes. Side effects from this surgery can include impotence and incontinence, Bill-Axelson said.

At first glance, the latest findings appear to contradict those from research reported in the May 4 issue of the Journal of the American Medical Association. That study concluded that hormone therapy wasn't better for local, low-grade prostate cancers than "watchful waiting" and likely would not improve patient survival rates, for up to 15 years after diagnosis.

Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Clinic Foundation in New Orleans, said the studies don't really contradict each other because their designs were different.

What both studies do show, he said, is that "in the prostate cancer world, we're still trying to pick which people need to be treated and which don't. The bottom line is that treatment of prostate cancer needs to be individualized."

The Scandinavian analysis tracked eight-year outcomes in 695 men diagnosed with early-stage prostate cancer. The men averaged 65 years of age and were recruited from 14 centers in Sweden, Finland and Iceland.

Patients were randomly assigned to receive either radical prostatectomy (347) or watchful waiting (348), where doctors simply keep close tabs on the prostate over time.

Less than 9 percent of the men who received radical prostatectomy died from prostate cancer, compared to 14.4 percent in the watchful waiting group.

Overall mortality was also reduced for the surgery group. After 10 years, 27 percent of those in the radical prostatectomy group had died from any cause, vs. 32 percent in the watchful waiting group.

Prostate cancer treated with radical prostatectomy was less likely to spread locally or to distant sites. After 10 years, 19.2 percent of the men in the surgery group had local progression, while 15.2 had distant progression of their prostate cancer. In contrast, in the watchful waiting group 44.3 percent experienced local progression, while 25.4 percent had their cancer spread.

"This is the first randomized study that shows there is a survival benefit with radical prostatectomy. [It] significantly reduces prostate cancer mortality, risk of metastases, risk of local tumor progression and overall mortality," said Bill-Axelson.

Brooks advised that any man diagnosed with prostate cancer talk with several physicians about what his best course of action would be. And that answer, he said, will be different for each patient.

Some men can safely choose no treatment because their prostate cancer is slow-growing and they may have other conditions, such as heart disease, that would be more likely to cause their death. But, Brooks said, if you're younger and otherwise healthy, you may want to be treated because you'll likely live long enough that the prostate cancer will begin to cause symptoms, and possibly death.

Bill-Axelson said the difficulty with prostate cancer is that while it's easy to detect who has it, it's not so easy to predict who'll die from it.

"The risk of over-treatment is striking," she said.

"Since, in absolute terms, the reduction in mortality is moderate, clinical decision-making and patient counseling will remain difficult," the authors wrote. "The additional finding that radical prostatectomy substantially reduces the risk of metastasis and symptomatic local tumor growth may, however, be of some help in guiding therapy."

More information

To learn more about prostate cancer treatment, visit the National Cancer Institute.

SOURCES: Anna Bill-Alexson, M.D., urologist, University Hospital, Uppsala, Sweden; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Clinic Foundation Hospital, New Orleans; May 12, 2005, New England Journal of Medicine

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