“Prostate cancer is a slower growing cancer,” says Elsasser. “There’s no evidence that it’s beneficial to have my prostate removed at this time.”
However, the latest research suggests that men such as Elsasser might want to rethink their decision.
Research published in today’s New England Journal of Medicine shows that radical prostatectomy, or surgical removal of the prostate, can cut a man’s risk of dying from the disease.
And although surgery carries with it side effects, such as impotence and incontinence, patients’ overall quality of life after the procedure may be no different than those who have taken a “watchful waiting” approach. This means that no immediate treatment is given, and the patient is instead monitored for signs that the disease has progressed.
A study of 695 men with prostate cancer found that after eight years, men who were part of the “watchful waiting” group had a 27 percent chance of dying from the disease. With surgery, the risk was cut in half to 13 percent.
“This is the first well-designed clinical trial that actually shows us that surgical removal of the prostate does something positive,” Dr. Otis Brawley, associate director of cancer control at Emory University in Atlanta, tells ABCNEWS Medical Correspondent John McKenzie.
The study also found that among the “watchful waiting” group, 14 percent saw their prostate cancer spread into their bones. Those who got surgery had only half the risk.
However, the risk of death from any cause was comparable in both groups.
The second study found that impotence and urinary incontinence were common problems after radical prostatectomy, but many men in the watchful-waiting group also reported these conditions.
Eighty percent of surgery patients had erectile dysfunction, as did 45 percent of watchful-waiting patients, which, according to the study researchers, could have been due to growing tumors in some cases. Watchful-waiting patients were also more likely to have an obstruction blocking urinary flow.
The question of whether to aggressively treat early prostate cancer is controversial, due to both the nature of the disease and the risks of treatment.
Because a decreased risk of death is associated with the surgery, some physicians believe this is a landmark study.
“The key finding is that prostate cancer mortality is cut in half,” says Dr. Tomasz M. Beer, assistant professor of medicine at Oregon Health and Science University. “Overall survival benefits in this setting are difficult to detect not only because of the small sample size but also because of the contribution of competing causes of mortality.”
Dr. Michael Koch, chairman and professor at Indiana University agrees, and points out that up until now, there have been no other studies to compare these results to.
“Physicians rely on evidence-based methodology to make therapeutic decisions whenever possible but in localized prostate cancer the data was not previously available. The study is well-done and seems to have clear-cut results,” he says.
However, others are quick to point out that, according to the research, while the risk of dying from prostate cancer is reduced by undergoing surgery, the chances of dying from something else remain the same, and question the importance of the surgery.
“If men with prostate cancer have a substantial risk of dying from prostate cancer, then an effective prostate cancer treatment should significantly increase overall survival,” says Dr. Paul A. Godley, professor of hematology/oncology, University of North Carolina at Chapel Hill. “If it doesn’t, then either the treatment is ineffective or men are not at substantial risk of dying from prostate cancer and the treatment is unnecessary. The key question is, ‘do men with localized prostate cancer need to be treated aggressively or are they more likely to die from other causes?’”
Dr. Richard Roberts, professor of family medicine at the University of Wisconsin Medical School, says the study is not one that doctors will point back to five years from now as having dramatically changed the practice of medicine.
“It reports nothing new. It has been common knowledge that radical prostatectomy results in erectile dysfunction and incontinence and that advanced local disease causes obstruction. My biggest disappointment was that this Swedish group missed an opportunity to answer some important questions about prostate cancer and quality of life,” he says.
And although the data confirms the presence of those side effects after radical prostate surgery, the study says overall they’re equal among men.
“What is very surprising to me is that the article concludes that there is little difference overall in quality of life. I would have thought that a doubling of impotence and incontinence would have a major impact on overall quality of life,” says Dr. Derek Raghavan, chief of oncology at the University of Southern California, Los Angeles.
More Questions Remain
In the United States, most men find out they have prostate cancer when they undergo a PSA screening test that detects a protein in the blood indicative of the disease at its earliest stages.
However, only a small percentage of the men studied were diagnosed using this test. So it is not certain whether surgery for cancers that small would be better, or worse, than it was for the large tumors.
Until now, about all doctors knew for certain about the surgery were its risks. A survey by the National Cancer Institute found that a year-and-a-half after the operation, 8 percent of men were incontinent and 55 percent were impotent. Some surgeons say the results of today’s study may make those risks more acceptable to men.
“I think they will help men,” says Dr. Peter Scardino, chief of urology at Memorial Sloan-Kettering Cancer Center in New York. “They will give men stronger evidence that treatment of prostate cancer really has a benefit.”
This latest research, however, does not address which treatment is best: surgery or different forms of radiation. That kind of controlled study has yet to be done.
World News Tonight’s Medical Correspondent John McKenzie contributed to this report.
Revision date: June 14, 2011
Last revised: by Janet A. Staessen, MD, PhD