Prostate Cancer: Early Surgery or Watchful Waiting?
Study Shows Early Surgery Cuts Deaths From Low-Risk Prostate Cancer
Prostatectomy for Low-Risk Prostate Cancer?
Possibly the most important study finding is that among these younger men, surgery improved survival even in those with prostate tumors considered to be low risk -- by the standards of the decade 1989-1999.
"When we say the low-risk group benefits from surgery, it is not as we would define a low-risk group by today's standards," Bill-Axelson says. "It is important that people don't panic and all go for surgery. It is important to have people closely watched and to undergo surgery when necessary."
There are degrees of "low risk" for prostate tumors, says prostate cancer expert Matthew R. Smith, MD, PhD, director of the genitourinary malignancies program at Massachusetts General Hospital. Smith's editorial accompanies the Bill-Axelson study in the New England Journal of Medicine.
Smith notes that in the Swedish study, 88% of the men had tumors that could be felt on a rectal exam, and only about 5% had their cancer detected via PSA screening tests. In the U.S. today, fewer than half of men diagnosed with prostate cancer have tumors that can be felt on a rectal exam, and most cancers are detected via PSA screening.
This means that today, most prostate cancers are diagnosed seven to 10 years earlier than they were when the men in the Swedish study were diagnosed.
"Since these cancers were not well represented in the Scandinavian study, we cannot generalize from this to say men diagnosed with low-grade cancer today would derive the same benefit. We still don't know if we have to treat all of those men," Smith tells WebMD.
But Smith agrees with Bill-Axelson that immediate treatment isn't necessary for all of these men. When a patient's biopsy shows that a prostate tumor has a low grade, and that tumor volume is small, the patient is a likely candidate for active surveillance.
For some doctors, "active surveillance" differs a bit from "watchful waiting" in that the tumor is carefully monitored, with repeat biopsies as necessary, so that a patient gets appropriate treatment as soon as the cancer progresses -- but well before it becomes a high-risk tumor.