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
The study followed 731 men with cancer than had not yet spread beyond the prostate. The average age of men in the study was 67.
About half the men were assigned to have radical prostatectomies; the other half were assigned to observation. All the men saw a doctor every six months. They had bone scans every five years to check for cancer spread to the bone.
"This really is the first large study to address the kind of men who are dealing with prostate cancer as it's being diagnosed in the United States these days," primarily through PSA tests, says researcher Michael J. Barry, MD, a clinical professor of medicine at Harvard Medical School.
Based on a combination of factors that included a man's PSA, the way the cancer looked under a microscope, and the size of the tumor, doctors assessed how risky the cancer appeared to be. Forty percent of men in the study had tumors that were considered low-risk; 34% were intermediate-risk; and 21% were considered high-risk.
After an average of 12 years, there was no significant difference in the number of overall deaths or deaths related to prostate cancer between the two groups -- 47% of men who had surgery died compared to 49.9% of men who didn't have surgery. Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, compared with 31 men (8.4%) assigned to observation -- a difference so small that it might have been caused by chance alone.
Only men who had PSA levels higher than 10 and perhaps those with intermediate- or high-risk tumors appeared to gain any benefit from surgery.
"What was remarkable was that even with observation, the chance of dying of prostate cancer was quite low -- about seven chances in 100 over 12 years," Barry says. "People have always said that for these PSA-discovered cancers that you're much more likely to die with prostate cancer than of it, and I think we proved that's way more likely."
Advice to Patients
Thompson says that men who are diagnosed with prostate cancer are lucky in at least one respect: Because the cancer is typically slow-growing, they have plenty of time to make a careful decision about how to handle it.
"For most prostate cancers, you have the luxury of taking the time to make a very informed and very methodically processed determination," he says.
The first thing to consider is your age. One in six men will get prostate cancer at some point in their lives. Doctors rarely recommend treatment for those diagnosed over 75 years of age.
Other factors to consider are your family history and the aggressiveness of disease. A PSA over 10, and a Gleason score over 7, are some indicators of a more aggressive cancer. A Gleason score is based on how the cancer cells look under a microscope.
"Over a 10-year period, a person who doesn't have an aggressive prostate cancer is not going to benefit from an operation," Carter says.