A new study of prostate-cancer outcomes confirms what earlier reports have hinted at. While men with aggressive forms of the disease might be helped by surgery, for patients with slow-moving tumours, the benefits are less obvious.
A team of American researchers followed 731 early-stage prostate-cancer patients for 20 years. They concluded: “Surgery was not associated with significantly lower … prostate-cancer mortality.”
Specifically, of those who had surgery, just four per cent fewer died of the disease than those who did not have surgery. That’s well within the study’s margin of error.
Indeed among both groups, a total of only nine per cent succumbed to their cancer. That’s because this is, in many cases, a slow disease and also, most often, a disease of the elderly. Most patients die of old age before their cancer becomes life-threatening.
The team did find, however, that surgery can result in serious side-effects, including impotence and incontinence. Care must be taken: These are both conditions that become more prevalent with age.
Nevertheless, the statistics are troubling. Among patients who had surgery, 40 per cent experienced incontinence. The baseline rate among non-surgery patients was five per cent.
And a stunning 80 per cent of men who had surgery suffered impotence, roughly twice the rate in non-surgery patients. While both conditions can be treated with varying degrees of success, side-effects such as these can have a serious impact on quality of life.
One note: The study looked only at surgery as a treatment for prostate cancer. There are other options, including radiation, hormone therapy and chemotherapy, which were not included.
The study raises a further issue. Men over 50 might be advised by their physicians to have regular screening tests for prostate cancer. These include blood tests looking for the prostate-specific antigen, and digital rectal exams.
While neither of these procedures is definitive, a positive result is usually followed by a biopsy, which is almost always accurate. But it’s here that difficulty arises.
If a patient is found to have prostate cancer, but the tumour is slow-moving, surgery might not be advised. Instead, these men are placed under “watchful waiting,” meaning they must return for further tests every six months. If the cancer grows more aggressive, surgery or some other form of treatment might be employed. Otherwise, the watchful waiting continues.
Yet living with cancer while only watching it is a daunting proposition. A regimen of this kind can take its toll. Some men eventually elect to have surgery, even if their tumour is static, simply to end the suspense of living on a volcano.
To date, this approach has been justified on the basis that if an aggressive cancer is found, surgery might save the patient’s life. On that basis, it’s worth putting thousands of men through the alternative procedure — watchful waiting.
But if the benefits of surgery are not as pronounced as once thought, should this change our thinking about prostate screening and treatment?
First, it’s important to remember that prostate cancer is a leading cause of death in men. Second, we’re dealing here with just one study, albeit a robust study.
The correct answer might be that this is a choice men must make for themselves. For those who can live comfortably with watchful waiting, it might be the best option.
But perhaps the most important conclusion is that physicians should take the time to explain the pros and cons when advising their patients. That has always been a requirement before any medical procedure is begun.
However, with the benefits of surgery now reduced in scope, that obligation becomes more important.
