July 19, 2012
Surgery Not The Best Idea For Prostate Cancer
Lawrence LeBlond for redOrbit.com - Your Universe Online
Men with early stages of prostate cancer may be better off having their disease monitored rather than going through harsh treatments such as surgery, according to a recent study that found that men in their 60s who had the invasive surgery actually didn´t live significantly longer than those who were only monitored.Results of the research, published Wednesday in the New England Journal of Medicine, suggests that men do not need immediate treatment, especially if their PSA scores are low or they have low-risk tumors that are unlikely to rapidly grow and spread.
Overall, most men in the clinical trial, performed at Massachusetts General Hospital and other facilities, did not benefit from surgery and did not reduce the likelihood they would die from prostate cancer or other causes.
However, the researchers did find that surgery did reduce mortality in two groups of men - those with relatively high PSA levels (greater than 10 ng/mL) and those with higher-risk, more aggressive tumors.
“What we found really suggests that treatment has a limited effect for most tumors and that PSA screening is finding many cancers that wouldn´t have otherwise caused problems,” said study coauthor Dr. Michael Barry, chief of general internal medicine at Massachusetts General Hospital.
The trial involved 731 men with an average age of 67 and who were diagnosed with early-stage prostate cancer detected by PSA screening, rectal exams and biopsies. Roughly half the patients were randomly selected to have their prostate removed through surgery and the rest received monitoring only.
PSA testing and bone scans were done on the monitor only group every six months for the duration of the study to search for signs of tumor spreading.
After 12 years, 47 percent of men who had the surgery died, compared to 49.9 percent of the men who were assigned observation only; the difference was not statistically significant. What was significant, however, was that more than one in five men who underwent surgery had adverse effects, although those with PSA scores greater than 10 did benefit from the operation.
About 17 percent of those having the surgery ended up getting urinary incontinence compared with 6 percent who did not have the operation. Furthermore, 81 percent in the surgery group had erectile dysfunction compared with 44 percent of those who were only monitored.
About 20 percent of those in the monitoring group eventually opted for treatment during the study because of personal choice or because their cancers appeared to be progressing during the biannual screenings.
Based on the study findings, lead author Dr. Timothy Wilt said: “observation is a wise and right decision for men with prostate cancer detected by PSA.” he noted that this study agreed with the recent recommendation by the US Preventive Services Task Force (USPSTF), which recommended in May that PSA screenings should not be used for testing prostate cancer in men.
About 66 percent of the 240,000 American men who are diagnosed with prostate cancer each year have tumors that pose little risk of spreading. Yet, nearly 90 percent of these men still have surgery or radiation, which may cause side effects such as impotence and incontinence. The troubling issue is that current tests aren´t able to accurately distinguish between aggressive cancers and non-threatening tumors.
An accompanying editorial to the study pointed out that the researchers´ failure to enroll 1,200 men as was originally planned may have made it impossible to detect modest but significant reduction in deaths in the group who had immediate surgery.
Some cancer experts said the study´s findings do not apply to younger men. A large percentage of those under 65 with early stage prostate cancer will most likely still opt for immediate treatment, according to Dr. Anthony D´Amico, chief of genitourinary radiation oncology at Brigham and Women´s Hospital.
“We can´t conclude from the study data that a healthy 50-year-old man with low-risk disease should skip treatment because the follow-up isn´t long enough to determine whether his disease will progress,” D´Amico said.
Most experts acknowledge that this study helps identify which patients do not require surgery for prostate cancer. However, most disagree with the idea that all prostate cancer detected with PSA should simply be observed.
“With early diagnosis and improvements in treatment during the past 20 years, the prostate cancer death rate has decreased by 44 percent in the U.S.,” Dr. William Catalona, medical director of the Urological Research Foundation, told ABC News.
“This trial should not provide men with another excuse not to get tested or treated for prostate cancer,” added Catalona, who developed PSA screening for prostate cancer.
“Rather than characterizing the study as showing no benefit from surgery compared to observation, this study provides evidence that surgery will reduce metastasis and death from prostate cancer particularly in men with intermediate or high risk tumors,” said Bruce Trock, professor and director of the Division of Epidemiology in the Brady Urological Institute.