The researchers also studied a group of men with tumours of the least aggressive kind (a low-risk group), even there finding differences in survival rate depending on whether surgery was performed. The low-risk group in question cannot, however, be perfectly compared with currently defined low-risk groups, and better markers will be required to determine the likelihood that low-risk tumours will assume a more aggressive form.
"The study shows that surgery reduces the risk of mortality due to prostate cancer, even for men with low-risk tumours," says Anna Bill-Axelson, chief physician at the Department of Surgical Sciences at Uppsala University. "But not everybody benefits from surgery, so individual risks and potential gains have to be assessed on the basis of age, other illnesses, tumour type and patient preferences."
Another finding of the study is that that surgical patients whose tumours had grown beyond the prostate gland ran a seven-times-greater risk of mortality due to prostate cancer than those whose tumours were limited to the prostate gland. The former group can greatly benefit from adjuvant treatment such as radiation therapy.
The most common side effects of surgical treatment were impotence and incontinence. More patients in the watchful-waiting group required ameliorative treatment due to tumor progression (hormone therapy) after a number of years. Both early side effects due to surgery and late side effects due to ameliorative treatment impact the quality of life of patients and must be part of discussions with patients about treatment options.
The study, designated "SPCG-4" (Scandinavian Prostate Cancer Group Study 4) was financed by the Swedish Cancer Society and, in recent years, also by the National Institutes of Health in the US.
A major study similar to the SPCG-4 study is currently under
|Contact: Anna Bill-Axelson|