BY MONIFA THOMAS Health Reporter /mjthomas@suntimes.com July 18, 2012 4:02PM
Dr. Greg Zagaja, center, prepares to perform a robotic prostatectomy on a patient at University of Chicago Medical Center using a da Vinci Si robotics system, left, Tuesday, Oct. 13, 2009 in Chicago. A study, appearing in Wednesday's Journal of the American Medical Association suggests the less-invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotence when compared with traditional surgery. (AP Photo/M. Spencer Green)
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Updated: July 18, 2012 8:02PM
Should men with prostate cancer have surgery right away or wait to see if it?s really needed?
That has long been the question for men found to have prostate cancer at an early stage, because such cancers tend to grow slowly and only three percent of people who have the disease die from it.
The latest study which aimed to answer that question has been found to have no statistical benefit in having surgery versus active observation.
Published in the New England Journal of Medicine on Wednesday, the study looked at 731 men who were age 67 on average and had localized prostate cancer. Of the 364 men who had radical prostatectomy, 5.8 percent died of prostate cancer or treatment over about 12 years of follow-up, compared to 8.4 percent of the 367 men who were observed.
However, the less than three percentage point difference between the two groups was not enough to be statisticalsignificant.
Adverse events affected 21 percent of men who had surgery, including one death.
Lead author Dr. Timothy J. Wilt said his study adds to a growing body of evidence that supports active observation, particularly among men whose prostate-specific antigen (PSA) is 10 or lower ? which means they are at low risk.
?What we now know is that for the vast majority of men currently diagnosed, observation should be the preferred treatment approach. It helps them with a long, healthy life, avoid death from prostate cancer and prevent treatment-related harms,? said Wilt, a professor of medicine with the Center for Chronic Disease Outcomes Research at Minneapolis Veterans Affairs (VA) Health Care System.
But not all doctors are convinced.
Three doctors who wrote an editorial in the New England Journal of Medicine pointed out that the study contained 731 patients, instead of the original intent of 2,000 patients. As a result, the study was ?underpowered? to detect a benefit with surgery.
?Despite these limitations, a trend toward a reduction in mortality was seen among men with high-risk cancers who were undergoing radical prostatectomy,? Dr. Ian Thompson Jr. and Catherine M. Tangen wrote.
Dr. William Catalona, director of the clinical prostate cancer program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, also said it would be ?misleading? to extrapolate the results of the study to the general population, because the men in the study were from VA hospitals and had a higher rate of dying from other health issues, leaving a relatively small number of men who were killed by prostate cancer in both groups.
The American Cancer Society recommends that patients decide which path makes sense for them by talking to their doctor about their particular risk factors.
Active surveillance or watchful waiting, as observance is commonly known, has a possibility of an aggressive cancer being missed and the window for potentially life-saving treatment being missed.
For that reason, it?s safer to intervene than ?wait and see.?
Treatments like surgery and radiation, meanwhile, can cause urinary, bowel and sexual side effects that may seriously affect a man?s quality of life.
Most doctors recommend surgery and other treatments, and more than 90 percent of patients follow that advice.
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