New study says surgery still the best option for prostate cancer

May 11 2005

A study by Swedish researchers has found that men who opt to have cancerous prostates surgically removed, have higher long-term survival rates than those who delay the operation, and the benefits of surgery may be greatest for men under 65.

The study, was designed to help doctors and their patients find the best strategy for treating tumours which occur in 230,000 men in the U.S. each year. Because prostate cancer often grows so slowly that patients die from other causes first, the issue is complicated.

The new findings update research begun in 1989 that showed 347 men assigned to a surgery known as radical prostatectomy had similar death rates comparable to the 348 men who were put in a "watchful waiting" group, and looked at an additional three years of data, which does suggest that patients can't wait forever.

The team, led by Anna Bill-Axelson of University Hospital in Uppsala, Sweden, found that during a 10-year period, men who received the surgery were 44 percent less likely to die of prostate cancer, 26 less likely to die from any cause, and 67 percent less likely to have their tumours grow or reappear, but the findings may not apply to everyone. The researchers found evidence that men 65 and older are not harmed by being in the "watchful waiting" group.

According to the study "the reduction in disease-specific mortality as a result of radical prostatectomy was greatest among, or even limited to, patients younger than 65", the study didn't include enough older men to be definitive.

Bill-Axelson team says that because the actual numbers were small, 8.6 percent of the men assigned to surgery died from prostate cancer, compared to 14.4 percent in the "watchful waiting" group, there remains ambiguity about which treatment is best. They predict the benefits of the surgery will increase during longer periods of follow-up.

Since the study began, more doctors have been measuring levels of the chemical PSA in patients' blood to monitor whether a tumour has reappeared and started to grow, and the researchers say that technique might increase the success rate of the watchful waiting strategy.

In conclusion they say, to date, there is no evidence that adding PSA testing and treating men based on those levels "will yield better results than will watchful waiting as used in this trial."

The study is published in the current New England Journal of Medicine.