New research suggests surgery may be best for young prostate cancer patients March 12, 2014
New research suggests that young men who undergo early prostate cancer surgery have a better chance of survival than those whose chose a watchful waiting strategy – fueling a debate over the best way to treat men with slow-growing tumors.
The randomized study conducted over 23 years by researchers from Sweden and the Harvard School of Public Health and was published in the New England Journal of Medicine. Researchers looked at 695 prostate cancer patients and divided them into two groups; watchful waiting and surgery.
What they found was that men under the age of 65 who underwent surgery to remove their prostate gland were less likely to die from the disease than those who were not treated unless their cancer progressed – an approach called watchful waiting. However, men over the age of 65 who underwent surgery did not decrease their risk of death, but did see a small reduction in the risk of the cancer spreading to other organs.
As a prostate cancer surgeon, this is huge news that we have been awaiting for more than two decades. For years, experts have hotly debated the best approach to prostate cancer treatment in men of this age group – weighing the benefits of surgery outcomes with the risk for side effects associated with prostatectomy, which can include urinary incontinence and erectile dysfunction. Hopefully, these findings will put an end to the debate.
Diagnosing early-stage prostate cancer
The PSA (Prostate Specific-Antigen) test that is currently used to help determine problems in the prostate is not specific to cancer – it simply tells the physician something is going on in the prostate. If the physician suspects something, antibiotics may be given to rule out an infection, and if problems persist, your doctor will usually do a digital rectal exam to see if there is a nodule that the PSA didn’t pick up.
If a patient has an abnormal PSA, he is referred to a urologist. The gold standard for a healthy prostate is having a PSA of under 4; however, this is not an absolute number – but rather a trend that must be followed by looking at how fast the PSA is increasing. Regardless of the outcome, it doesn’t mean that every person who has prostate cancer needs surgery. Doctors must individualize the care.
So, what does this mean for prostate cancer treatment?
While it may appear evident that prostate cancer treatment improves survival, not all experts agree. Based on disease variables and treatment side effects, some specialists believe the cancer will sleepily reside in the prostate gland, while others assert that it can spread quickly and without warning. I encourage my patients to thoroughly weigh risk of disease spread with risk of treatment side effects.
It is important to note that the decision to wait out prostate cancer does not mean a life free from side effects. In fact, the “waiting” participants in this study experienced an increased risk of metastases and many required palliative treatment, such as hormone therapy. Even without short-term treatment, watchful waiting means frequent follow-up and repeated prostate biopsies that can result in both physical and emotional strain.
Some men are leery that prostate removal surgery will impact their ability to have sex or control their urine. However, previous studies have demonstrated that surgeon experience and hospital volume can significantly improve recovery in these two areas.
The important thing to remember is that these findings are not simply about prostate cancer treatment being effective – they specifically point to the efficacy of prostatectomy surgery in improving long-term survival and quality of life – but the best outcomes come from a good surgeon.