Prostate Surgery Often Presents More Problems Than It Solves

Routine screening for prostate cancer has been in the news a lot lately, and attention was renewed recently when the U.S. Preventive Services Task Force recommended that the PSA test be canceled for most men. Those experts concluded that only one life is saved for every 1,000 people screened over a 10-year period, that the rate of false positives is high and the side effects of treating them and cancers that are growing so slowly as to present little threat are unacceptable.

A new study published in the New England Journal of Medicine looked at surgery for early-stage prostate cancer patients and concluded much the same, as reported in the Los Angeles Times. “Most patients diagnosed with early-stage prostate cancer will live just as long if they simply watch their cancers rather than have them surgically removed.”

The problem with surgery as the default response to early-stage cancer is that the side effects are often worse than the disease-specifically, wound infection, urinary incontinence and sexual dysfunction. The study did find a slight benefit of surgery for patients with higher risk early cancers, including those whose blood levels of prostate-specific antigen (PSA) measure above 10 nanograms per milliliter or who had larger tumors whose cells appeared abnormal.

But for most men, “The trial gives us results that we have been waiting for in urology for quite some time,” Mark S. Litwin, chairman of the UCLA department of urology, told the L.A. Times. “It confirms many of the recent reports that men with prostate cancer, by and large, can be safely managed with close monitoring.”

That’s known as “watchful waiting,” and it’s rapidly being accepted as best practice for most patients with prostate concerns.

About half of the study subjects, who were tracked for about 10 years, died during the course of the study. Most of those deaths were not from prostate cancer, the authors noted, reinforcing the notion that more men die with prostate cancer than from it. Prostate disease affects 1 in 6 men.

The likelihood of death from any cause was the same for patients who had surgery and those who didn’t.

Because only 1 in 10 of the study participants was younger than 60, its conclusions don’t necessarily apply to them. So for young patients, the jury is still out.

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