Major Study Backs Removal of Prostate
Surgically removing the prostate is superior to “watchful waiting,” a no-treatment tactic often pursued when cancers are small and confined to the gland, medical researchers report in a major investigation released last week.
Zeroing in on one of the biggest controversies in medicine--how best to treat early prostate cancer--the Swedish study of 695 men shows that radical surgery can reduce by nearly half the chance of dying from the disease.
“I am thrilled with the findings. Absolutely thrilled,” said Dr. Patrick Walsh, director of urology at Johns Hopkins University in Baltimore. “There has been so much hype in the [medical] literature about watchful waiting. This investigation put it to the test.” Walsh called the findings a landmark and said they add to the data that doctors can share with patients seeking information about treatment. Prostate cancer is the second-leading cause of cancer deaths among men.
“Surgery not only reduced death, it also reduced the probability of distant metastases,” Walsh said of prostate cancer spreading to bones or other sites. Led by Dr. Lars Holmberg of the University Hospital in Uppsala and reported in Thursday’s New England Journal of Medicine, the study is the first large-scale trial in which surgery and watchful waiting are compared. Half the group was given a radical prostatectomy. The others were monitored periodically but not treated. Men in the study lived in Sweden, Norway and Finland.
Holmberg found six years after diagnosis that 31 men in the watchful-waiting group died of prostate cancer compared with 16 who had surgery. Deaths from all causes--other forms of cancer or medical conditions--were not statistically meaningful, Holmberg said. Watchful waiting is the primary standard of care in Scandinavia. It evolved as an option worldwide because it allows men with local tumors to avoid problems associated with prostate removal: incontinence, bowel obstruction and erectile dysfunction.
But Walsh said such problems are possibilities with untreated tumors. “Local prostate cancer is a formidable enemy,” he said. Dr. Otis Brawley of the Winship Cancer Institute at Emory University in Atlanta applauded the study but said another underway by the Veterans Administration will probably produce less of a statistical difference in the two approaches. Here, he said, doctors find smaller cancers because of screening, not widely used in Scandinavia.
