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Young men with early-stage prostate cancer who undergo surgery right away, instead of waiting to see if their cancer progresses, may lower their chances of dying from the disease over the long term, a new study from Scandinavia suggests.
In the study, men with localized prostate cancer (cancer located only inside the prostate gland), who underwent surgery called a radical prostatectomy were 44 percent less likely to die from the disease over the next two decades, compared with men whose cancer was observed through "watchful waiting" to see how it progressed.
However, the reduced risk of dying from prostate cancer was seen only in men who were younger than 65 at diagnosis, or whose tumors had a medium risk of spreading (as opposed to a low or high risk), suggesting that these men benefited the most from surgery.
"In order to derive a benefit from surgery, men need to have a very long life expectancy," said study researcher Jennifer Rider, assistant professor in the department of epidemiology at Harvard School of Public Health. [8 Tips for Healthy Aging].
The researchers say their findings should be interpreted with caution because men in the study were diagnosed at a time when screening for prostate cancer was not common. With prostate cancer screening today, cancers are typically diagnosed five to ten years earlier than without screening.
Benefits of surgery?
The question of whether younger men with prostate cancer should have surgery right away, or can wait to see how it progresses, has been controversial. That's because prostate cancer is often slow to progress, and surgery can have significant side effects, including a risk of erectile dysfunction or urinary incontinence.
Dr. Judd Moul, director of the Duke Prostate Center in Durham, N.C., who was not involved with the study, said doctors are likely to interpret the results in different ways, with some using the findings to try to persuade younger patients to have surgery, and others using the paper to reassure some patients they're probably OK to do active surveillance.
A big issue for younger men is the risk of erectile dysfunction that comes with surgery, Moulsaid.
"The real crux of the matter is, the younger men are concerned that if they take surgery it will affect their sexual function," Moulsaid. "For many patients, it really boils down to sex versus life."
The study involved 695 men with early-stage prostate cancer who were randomly assigned to receive radical prostatectomy or watchful waiting between 1989 and 1999, and followed for up to 24 years.
During the study, 200 men in the surgery group and 247 men in the watchful-waiting group died. Of these, 63 deaths in the surgery group and 99 in the watchful-waiting group were due to prostate cancer.
An earlier version of the study found benefits to surgery, but in the new study, which had a longer follow-up time, the benefits were even more pronounced, Rider said. Eight men in the study needed to be treated with surgery to prevent one death from prostate cancer, the study found.
Wait and see
Although older men and those with low-risk prostate cancer who underwent surgery did not have a reduced risk of dying from the disease, they did have a lower risk of their cancer spreading, and were less likely to need hormone treatments compared to those in the watchful-waiting groups. Both cancer spread and hormone treatments are factors that can affect a person's overall quality of life, the researchers said.
Older men, and those with low-risk prostate cancer, primarily died of causes besides their cancer, Rider said.
The study also found that 40 percent of those in the watchful-waiting group who were still alive two decades later had not needed any surgery or other treatment for their cancer.
This finding "really shows that there is this large percentage of men with localized prostate cancer who can live for a very long time without any sort of major health consequences of their diagnosis," Ridertold Live Science.
"That points to the potential for over-treatment in these men," she said. In other words, if all men underwent surgery, some would receive a treatment they didn't need.
Moul noted that the "watchful-waiting" approach used in the study is different from the concept of active surveillance that doctors use today to observe prostate cancer, which involves more frequent assessment of the tumor progression. So it's not clear how well the study findings translate to today's patients, Moul said.
Ultimately, the decision of how to treat early-stage prostate cancer is an individual one that's made in consultation with a doctor, Moulsaid.
The study, which involved researchers at Uppsala University Hospital in Sweden and others, is published in today's (March 6) issue of the New England Journal of Medicine.