to remove the prostate saves lives compared to "watchful waiting"
for some men whose cancers were found because they were causing symptoms,
long-term results from a Scandinavian study suggest.
However, US men should not assume that immediate treatment is best, doctors
warn, because the study was done before PSA testing became common, and a newer
study found the opposite.
PSA blood tests are not recommended for screening by leading medical groups
but are widely used in the US, leading to a dramatic increase in the number
of prostate cancers found at a very early stage.
cancer: to screen or not
Whether to treat them is a big question. Most tumours grow too slowly to
threaten a man's life and there is no good way to tell which ones will. Treatments
can cause impotence, incontinence and other problems.
Testing less common in Europe
In Europe, PSA testing is far less common, and most prostate cancers are
found when they cause symptoms such as trouble urinating. Symptoms like this
suggest a larger or more advanced tumour.
of urine can indicate prostate issues
The study involved 695 such men in Sweden, Finland and Iceland, diagnosed
between 1989 and 1999. Half were given surgery to remove their prostates and
the rest were closely monitored and given surgery only if symptoms or signs of
Earlier results suggested that the surgery group fared better. That trend
strengthened as time went on. By the end of 2012, 200 men in the surgery group
and 247 in the group assigned to monitoring had died – 56% and 69%,
Immediate surgery most benefitted men younger than 65; it didn't reduce
deaths in those over that age.
"This study tells us we should be very careful about treating anyone
over the age of 65 . . . and anyone who has low-grade disease," said Dr Otis
Brawley, chief medical officer of the American Cancer Society.
A good trend
In the US, fewer men are getting treatment right away, and "that's a
good trend and we need to continue that," he said.
The US government, the Swedish Cancer Society, the Karolinska Institute, and
two foundations paid for the study. Results appear in this week's New England
Journal of Medicine.
in surgery for early prostate cancer
better for younger prostate patients
robotic surgery for early prostate cancer