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Prostate Cancer Surgery May Not Always Up Survival

Study Finds Surgery Doesn't Cut Death Risk Compared to Watchful Waiting for Early-Stage Prostate Cancer
By
WebMD Health News
Reviewed by Louise Chang, MD

July 18, 2012 -- For men with early prostate cancer, surgery to remove the prostate gland appears to offer no survival advantage over watching and waiting, a new study shows.

The study, which is published in the New England Journal of Medicine, suggests that many men who undergo the surgery, which is called a radical prostatectomy, are being needlessly exposed to the risk of debilitating side effects, including erectile dysfunction and incontinence.

The prostate is a walnut-sized gland that wraps around the junction of the bladder and urethra, the tube that carries urine out of the body.

Radical prostatectomy, where a doctor removes the prostate and some of the tissue around it, can damage the nerves and blood vessels that control the bladder and penis, leading to impotence and urine leakage.

Indeed, 81% of men in the study who had surgery to remove their prostate had erectile dysfunction within two years of their procedures, nearly double the ED experienced by men assigned to observation. Roughly 17% of men in the surgery group experienced urinary incontinence, about three times the percentage in the observation group.

The men in this study had their cancer diagnosed by a prostate specific antigen test (PSA). There has been a lot of debate over the effectiveness of this test at showing appropriate risk. In this case, the research shows that two-thirds of the men with a PSA below 10 who had surgery did not appear to have a real benefit from that surgery. On the other hand, some doctors would say a PSA of 10, even if the cancer has not spread beyond the prostate, is too risky.

Not everyone agrees. "There are far more people treated than are at risk of death from prostate cancer," says Ian M. Thompson Jr., MD, director of the Cancer Therapy & Research Center at the University of Texas Health Science Center in San Antonio.

"You may have a low risk of a tumor itself, and a far higher risk of side effects. A death from prostate cancer is [obviously] a huge side effect, but it tends to be down the road. On the other hand, a treatment-related urinary, sexual, or bowel complication, in the case of radiation may be more acute and for a longer period of time," says Thompson, who wrote an editorial on the study but was not involved in the research.

Surgery Becoming More Common

Prostate cancer is the second most frequently diagnosed cancer in men, behind skin cancer. But most prostate cancers are slow growing, and many men with prostate cancer live relatively untroubled by their tumors and will die of other causes.

Despite the good odds of survival associated with most cases, studies show that radical prostatectomy procedures are becoming more common. A study published in June in the Journal of Urology, for example, found the number of radical prostatectomies roughly doubled in the U.S. between 2004 and 2010.

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