Doubt over the worth of prostate surgery

Posted: Published on July 20th, 2012

This post was added by Dr P. Richardson

"The whole problem is selecting the ones which need to be operated on" ... Cancer Council chief executive Ian Olver. Photo: Natalie Boog

A LANDMARK study of prostate cancer surgery has found it does not appear to save the lives of men with early-stage disease and causes high rates of incontinence and erectile dysfunction.

In what has been described by experts as ''game changing'' research, American researchers tracked the progress of 731 men with prostate cancer over 12 years to see how surgical removal of the prostate compared with continuing observation of the cancer to see if it becomes more active or spreads.

The largest clinical trial comparing the two approaches to date found surgery did not significantly change the survival rate between the groups. After 10 years, 21 men or 5.8 per cent of those who received surgery had died from prostate cancer or its treatment, compared to 31 or 8.4 per cent of those whose doctors watched their progress.

However, in the surgery group, one in five men suffered a complication from the surgery called a radical prostatectomy. Two years on from the procedure, one man had died from it, 81 per cent suffered erectile dysfunction, 17 per cent had urinary incontinence and 12 per cent bowel dysfunction.

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After two years of observation for the other group, 44 per cent had erectile dysfunction, 6 per cent urinary incontinence and 11 per cent bowel dysfunction.

The researchers concluded that for men with early-stage cancer that had not spread from the prostate, radical prostatectomy did not significantly reduce the chance of death over 12 years.

''Our findings add to evidence supporting observation, and possibly active surveillance, for most men who receive a diagnosis of localised prostate cancer, especially those with a low PSA [prostate-specific antigen] value or low-risk disease,'' they wrote.

The findings, published in the New England Journal of Medicine, add to growing concern that the use of unreliable PSA tests is causing ''overdiagnosis'' of prostate cancer, which in most men will be so slow growing, it will not cause them harm.

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Doubt over the worth of prostate surgery

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