U.S. News
Study: Prostate Surgery Helps Some Men Live Longer
Patients With Early Stage Cancer More Likely to Survive Than Those Only Monitored
By Jeanne Whalen
March 5, 2014 5:03 p.m. ET
Men with early-stage prostate cancer who had their prostates surgically removed were significantly more likely to be alive nearly two decades later than men who went without surgery and were monitored through so-called "watchful waiting," the latest findings from a long-running Swedish study show.
The 700-patient study, which found similar results at earlier stages, is likely to heighten debate about the value of surgery versus observation or watchful waiting, which generally involves no immediate treatment. In recent years, doctors increasingly have embraced watchful waiting, in part because other large studies have shown that surgery provides no benefit yet has potentially undesirable side effects.
Operate vs. Monitor
Early-stage patients are more likely to survive after prostate removal than observation.- 347 patients treated with surgery
- 348 patients treated with observation or watchful waiting
- 200 out of 347 in the surgery group
- 247 out of 348 in the watchful-waiting group
- 63 out of 347 in the surgery group
- 99 out of 348 in the watchful-waiting group
The Swedish study, published Wednesday in the New England Journal of Medicine, showed that after 18 years, there were 13% fewer deaths from any cause, and 11% fewer deaths from prostate cancer specifically, in the group that had surgery versus the watchful-waiting group. By the 18-year mark, 200 of 347 men in the surgery group had died from any cause, versus 247 of 348 monitored men.
The benefits of surgery were most pronounced in men who were under 65 when diagnosed. In these patients, there were 25.5% fewer deaths from any cause and 15.8% fewer deaths from prostate cancer in the surgery group.
Among men 65 and older at diagnosis, there was no significant reduction in death in the surgery group, according to the study, which was led by a group of Swedish physicians and funded by the Swedish Cancer Society.
Moreover, men whose cancers had an intermediate risk of growing or spreading were more likely to benefit from surgery than men whose cancer had a low or high risk of spreading.
Among intermediate-risk patients, there were 24.2% fewer deaths from prostate cancer in the surgery group than in the watchful-waiting group. In low-risk patients, there were 3.8% fewer deaths from prostate cancer in the surgery group, a slim enough difference that the researchers said it could have been due to chance. Among high-risk patients, there was no significant difference in prostate-cancer death between the groups.
James McKiernan, director of urologic oncology at New York-Presbyterian Hospital and Columbia University Medical Center, said the results should help doctors better target patients for surgery. "On first pass, this looks like a green light to go operating on everyone, but what it really does is shed a lot of light on the subset of patients who will benefit from surgery," he said. "The younger patient with relatively aggressive cancer is the patient who will benefit most from treatment."
To find such patients, though, screening must be improved, he and other doctors said. The widely used blood test for prostate-specific antigen, or PSA, can often be inaccurate.
The Swedish results differed from those of another recent study called the Prostate Cancer Intervention Versus Observation Trial, or PIVOT, which showed surgery didn't reduce overall death or prostate cancer death compared with observation.
The Swedish patients, however, already had symptoms at the start of the study, meaning their cancers were more advanced than those of the PIVOT patients, who were diagnosed through PSA testing.
In the U.S. today, the average age at the time of diagnosis is about 66, according to the American Cancer Society.
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