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Surgery Not Best Option for Early Stage Prostate Cancers: Study

By Barbara Bronson Gray
HealthDay Reporter

WEDNESDAY, July 18 (HealthDay News) -- When a man learns he has localized prostate cancer, he has to make the difficult choice of surgery, and its possible side effects, or watchful waiting.

Now, a large, long-term study suggests that surgery to remove the prostate is no better than careful monitoring: Among men with low-grade, early-stage cancers, a radical prostatectomy did not reduce the risk of death from prostate cancer or from any other cause.

"This was a very important and difficult study to do because there are deeply held beliefs that early detection and treatment are beneficial," said study author Dr. Timothy Wilt, a professor of medicine at the Minneapolis VA Center for Chronic Disease Outcomes Research at the Minneapolis Veterans Affairs (VA) Health Care System. "We showed with prostate cancer there are small benefits to radical prostatectomy and the potential for harm."

Wilt said the results support the recommendations of the U.S. Preventive Services Task Force and should be reassuring for both patients and doctors: "Observation can leave patients with a good option, and is a good treatment choice," he said.

The findings were published July 19 in the New England Journal of Medicine.

In the study, the researchers randomly assigned 731 men with localized prostate cancer to either have surgery (radical prostatectomy) or observation. The men joined the study between 1994 and 2002, and were followed through January 2010. The average age of the men when the study began was 67 and their mean prostate-specific antigen (PSA) value was 7.8 nanograms per milliliter. All of the participants had negative results on bone scans -- evidence that they didn't have metastatic (or spreading) disease.

The researchers assessed problems associated with radical prostatectomy 30 days after surgery and noted issues of urinary incontinence, erectile dysfunction and bowel dysfunction after two years, as reported by the patients.

The investigators noted that the data was gathered in the early era of PSA testing. Current practice -- repeated PSA testing using a lower threshold for biopsy, doing more biopsies more frequently and systematically upgrading tumors to increase the detection of "indolent" cancers -- increases the likelihood of overdiagnosis and treatment, Wilt explained.

According to the U.S. National Cancer Institute, there will be about 241,740 new cases of prostate cancer in the United States this year.

In May, the U.S. Preventive Services Task Force recommended against PSA-based screening for prostate cancer. The task force said there is a very small benefit to the test and significant harms.

But other expert groups, most recently the American Society of Clinical Oncology, continue to recommend the tests, at least for those with a life expectancy of 10 years or more.

Dr. Durado Brooks, director of prostate and colorectal cancers at the American Cancer Society, said the latest study will be helpful to those facing a diagnosis of cancer and for the doctors who treat them.

Yet, when faced with a diagnosis of prostate cancer, the vast majority of men choose to do something very quickly, Brooks noted.

"This is partly because we haven't had any good long-term studies, but it's difficult to get past the fear of the word 'cancer,'" he explained. "The study shows the value in taking a step back and looking harder at watchful waiting or active surveillance."

More information

To learn more about prostate cancer, go to the U.S. National Cancer Institute.

SOURCES: Timothy J. Wilt, M.D., professor, medicine, Minneapolis VA Center for Chronic Disease Outcomes Research at the Minneapolis Veterans Affairs (VA) Health Care System; Durado Brooks, M.D., director, prostate and colorectal cancers, American Cancer Society; July 19, 2012, New England Journal of Medicine

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