Whether you Should have Surgery for Prostate Cancer

One of the problems with prostate cancer is that there is no easy way to tell if it’s going to progress very slowly or whether it may be aggressive and this leads to the dilemma of whether you should have surgery for prostate cancer in the early stages.

A recent article suggests that for men over 65 surgery may not confer any real advantage in terms of life expectancy. The article says:

 “The vast majority of men diagnosed with early-stage prostate cancer have surgery or other harsh treatments that can cause permanent side effects, but a study published Wednesday found that men in their 60s who had surgery didn’t live significantly longer than those whose cancers were merely monitored.”

“The clinical trial could be a turning point, shifting doctors toward more conservative treatment of men who are diagnosed with prostate cancer that hasn’t spread beyond the gland.”

One of the authors of the study written up and published in the New England Journal of Medicine said:

 “What we found really suggests that treatment has a limited effect for most tumors and that PSA screening is finding many cancers that wouldn’t have otherwise caused problems,”

The article explained that;

“The trial, published in the New England Journal of Medicine, involved 731 men with an average age of 67 who were diagnosed with early-stage prostate cancer detected via PSA screening, digital rectal exams, and biopsies. About half were randomly selected to have their prostate removed right away and the rest were monitored by doctors to see whether their cancer began to progress.”

 “After 12 years, nearly 6 per cent of men who had immediate surgery died of the cancer compared with slightly more than 8 per cent of those patients who were observed, which wasn’t a great enough difference to reach statistical significance. A subset of patients with high PSA readings did appear to benefit from surgery, however.”

“But men who had surgery had more side effects: About 17 per cent of them wound up with urinary incontinence compared with 6 per cent of those who skipped the treatment, and 81 per cent in the surgery group had erectile dysfunction compared with 44 per cent of those whose cancers were monitored.”

“About one in five men in the “watchful waiting” group wound up opting for treatment during the study because of personal choice or because their cancers appeared to be progressing during routine physicals; in the study, watchful waiting involved no set schedule of testing to monitor the cancers.”

“About two-thirds of the 240,000 American men diagnosed with prostate cancer every year have tumors that pose little risk of spreading, but nearly 90 per cent of them get treated with surgery or radiation, which can also cause side effects such as impotence. In part that’s because current tests aren’t able to accurately distinguish between aggressive cancers that will spread and kill if not treated and non-lethal tumors.”

“Some cancer specialists said the study’s findings don’t apply to younger men. A large percentage of those under age 65 with early disease will likely still opt for immediate treatment.”

The article would suggest that certainly any younger man diagnosed with prostate cancer should at least have active surveillance with yearly PSA testing and biopsy to check whether a cancer is progressing quickly and warrants immediate treatment. It is, however, a Hobson’s choice situation for many men since treatment can seriously impair one’s quality of life. Surgery can damage nerves in the area and cause irreversible erectile dysfunction and/or incontinence, whilst radiotherapy may shrink a cancer but rarely kills it completely, and also fixes it making surgery more difficult later.

The big problem would seem to be the unreliability of the PSA test, but there are rumours of a new way of testing for prostate cancer on the way and it is hoped that this may make it easier to decide whether you should have surgery for prostate cancer.