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Surgery Might Save Lives in Early Prostate Cancer

by Albert Fuchs, M.D.

May 6, 2011 | 10:58 am

Last week’s post, “Armadillos Transmit Leprosy to Humans”, generated much positive feedback, which I appreciated. You all clearly enjoy stories featuring cute mammals and very little serious science or health implications. I did my best to find a story like that this week, but the closest thing I found was that SEALs cause penetrating head trauma to a few particularly nasty humans.

But there was an important study this week about prostate cancer. My regular readers know that one of the controversies surrounding prostate cancer is that no one knows yet whether treatment of prostate cancer saves lives. That’s partially because prostate cancer grows so slowly and affects older men. It’s clear that many men with prostate cancer would live normal life-spans and die of some other cause if their cancer was ignored.

This week’s issue of the New England Journal of Medicine published a European study in which nearly 700 men with early prostate cancer were randomized to two groups. One group had surgical removal of their prostate. Another group underwent “watchful waiting” – no immediate treatment, with close surveillance for tumor growth or spread, and treatment at that later point.

Both groups were followed for an average of almost 13 years. The group that received surgery had significantly fewer deaths. There was one fewer death for every 15 patients randomized to surgery. The bulk of the benefit was in men younger than 65 at the start of the study. There was one fewer death for only 8 of these younger men who underwent surgery – an impressive demonstration of the benefit of surgery.

The conclusion of this study has important caveats which are detailed in the accompanying editorial and in the media coverage (links below). Most importantly, the patients in this European trial are very dissimilar to US prostate cancer patients. The patients in the study mostly had prostate cancer that was causing symptoms which led the patients to seek medical attention. In contrast, US patients are usually diagnosed through a PSA, a screening blood test. That means that the European patients had prostate cancer that had developed for many years longer than a typical American patient at diagnosis. So whether surgery would still be beneficial in even earlier cancer diagnosed by PSA is unknown. Also, this study did not assess other important treatment options for prostate cancer: radiation and hormonal therapy.

The breakthrough from this study is that we are now fairly certain that in some men with some types of prostate cancer treatment is lifesaving. Further defining which men with which tumors will benefit is the subject of ongoing research.

Next week, I’ll try to find something about syphilitic badgers.

Learn more:

Los Angeles Times Booster Shots: Prostate cancer surgery improves survival in younger men, Swedish study finds, but there are caveats

US News article: Aggressive Treatment May Be Beneficial for Early Prostate Cancer

New England Journal of Medicine article: Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer

New England Journal of Medicine editorial: Effective Treatment for Early-Stage Prostate Cancer — Possible, Necessary, or Both?

My most recent posts about the controversies of prostate cancer:

New Evidence Supports Prostate Cancer Screening

American Cancer Society Revises its Guidelines for Prostate Cancer Screening

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.

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ABOUT THE AUTHOR

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Practicing internal medicine in Beverly Hills since 2000, Dr. Fuchs brags that his practice is “tiny and meant to stay that way.” He has blogged for the past three years...

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