Early prostate cancer surgery improves survival

For men diagnosed with early Prostate cancer, one of their options is to wait to see if the disease progresses and then to undergo treatment if necessary. However, in terms of survival over the ensuing 10 years, immediate surgery seems a better choice, a Swedish study indicates.

The reduced death rate from Prostate cancer for those undergoing surgery rather than taking a "watchful waiting" approach is particularly evident among men younger than 65 years of age.

Dr. Anna Bill-Axelson, at University Hospital in Uppsala, and her associates previously reported that surgical removal of the prostate reduced mortality due to prostate cancer after an average of 6 years, although overall survival was not significantly affected.

Now, in this week's New England Journal of Medicine, Bill-Axelson's team reports on the 10-year survival estimates for this same group, which included 347 men younger than 75 years old who were randomly assigned to surgery and 348 to watchful waiting.

During follow-up, 50 men in the watchful waiting group (14 percent) but only 30 in the prostatectomy group (9 percent) died of Prostate cancer. Also, overall mortality rate was lower.

Among men below age 65, the cumulative incidence of death was 19 percent in the watchful-waiting group versus 11 percent for those who were assigned to immediate surgery.

While the reduction in mortality is moderate, the researchers expect the benefits of surgery will increase during longer follow-up - although surgery does have side effects.

As the team advises: "The more immediate, though stable, side effects associated with surgery (predominantly, impotence and incontinence) ... should be weighed against the increasing incidence of symptoms and use of treatments after the progression of disease in the watchful-waiting group."

SOURCE: New England Journal of Medicine, May 12, 2005.