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Surgery Helps With Prostate Cancer, Sometimes
Date:8/12/2008

slowly that it poses little danger to life from one that can grow aggressively enough to be fatal. A common medical saying is that "more men die with their prostate cancer than of it."

Uncertainty about prostate cancer treatment has led to a new federal recommendation that men over 75 should not have PSA tests because the risks of treatment outweigh the benefits.

A final answer about whether surgery and other aggressive treatment is preferable to merely watching the course of the disease will not come for years, Wong said. A controlled trial is under way in Europe, and one is planned for the United States, she said.

Meanwhile, the decision about treatment versus watchful waiting must be made for each individual, Wong said.

"I have discussions with a patient about his other medical conditions, his age, his willingness to receive treatment that may have long-term side effects, weighed against the risk that he may develop an aggressive cancer," she said.

Stephen Zeliadt, a research scientist at the Fred Hutchinson Cancer Research Center in Seattle, said the new study "does provide evidence that intervention in the form of surgery does have a curative effect for some men. The question is, which men?"

Another question is whether the study results apply to "a screening population" of men who have PSA tests, Zeliadt said. "With screening, you catch a lot of different types of cancer, and also at different ages. There is no information in the study on the age of detection."

So, Zeliadt added, this study doesn't help solve the prostate cancer riddle. "It probably makes it even more confusing," he said.

Dr. Peter T. Scardino, chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center in New York City, said the study did offer an important finding: "The big benefit of treating potentially lethal prostate cancer comes early, in the first five to 10 years."

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