Men who discover they have early-stage, localized prostate cancer and have surgery to have the tumor removed as well as part of the prostate do not live much longer than men who choose to simply monitor the cancer and receive no treatment.
In addition, about one-third of the men who did go through with the surgery reported side effects, such as infections, sexual and erectile dysfunction and urinary incontinence. Also, men that had the surgery tended to have more complaints about it impacting their daily living than the other men.
In a trial that began in November 2004, researchers enrolled 731 men with low-risk prostate cancer – cancer that has not spread beyond that organ – to either undergo surgery known as a prostatectomy or just observation. Under the latter, a doctor simply asks health questions to the patient that may or may not be connected to the prostate cancer.
The men were then tracked until August 2014 or until they died. While 7.4% of the men who received surgery died of prostate cancer over the time period, and 11.4% of the men in the observation group did, that result was not considered statistically significant, according to the study published in the New England Journal of Medicine. Also, 61% of men in the surgery group died for other reasons during the up to 20 years of study follow-up, compared with 67% of the men in the observation group. Again, this was not considered statistically significant.
“About 70% of patients newly diagnosed with prostate cancer are in the early stages, meaning the cancer is confined to the prostate gland, and they have nonaggressive tumors,” co-author Gerald L. Andriole, MD, director of Washington University School of Medicine’s Division of Urologic Surgery, said in a statement. “As such, these patients have an excellent prognosis without surgery. This study confirms that aggressive treatment usually is not necessary.”
However, results did show that some men with moderately aggressive prostate cancer and long life expectancy would live longer if they underwent the surgery.
“We hope the findings will steer doctors away from recommending surgery or radiation to their patients with nonaggressive early-stage prostate cancer and patients away from thinking it’s necessary,” Andriole noted.