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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

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.

"The idea that we are overtreating prostate cancer has been well known for a long time. Many men with low-risk prostate cancer will probably die of other causes rather than die of prostate cancer," says Manish Vira, MD, director of the Fellowship Program in Urologic Oncology at the North Shore-LIJ Health System's Smith Institute for Urology in New Hyde Park, N.Y.

For that group, says Vira, who was not involved in the research, treatment will almost certainly do more harm than good.

But other independent experts think the study is limited in what it can say because it only followed most people for around a decade. Because prostate cancers grow so slowly, says Ballentine Carter, MD, director of adult urology at the Johns Hopkins School of Medicine, 10 years may not be enough time to see a difference.

"In the world of prostate cancer, 10 years is not very long follow-up, he says. Because over a 10-year period, men who are diagnosed with a disease that's potentially harmful aren't harmed in 10 years, and the study shows that because very few people in either group died of prostate cancer," he says.

But there were important differences between the two groups in the number of men who went on to develop cancer that spread to the bone, Carter says.

In the surgery group, 17 men had their cancer spread to their bone over the course of the study, compared with 39 in the observation group. Surgery appeared to reduce a man's risk of having his cancer spread by about 60% over observation alone.

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