Study Backs Aggressive Treatment for Prostate Cancer
ROBERT SIEGEL, host:
Men with early prostate cancer face a tough decision. Surgery to remove the prostate has unpleasant side effects, but waiting to see if the cancer develops could be life-threatening. Patients and doctors have to make that decision with only a minimal amount of information. NPR's Joanne Silberner reports that a new study in this week's New England Journal of Medicine may help.
JOANNE SILBERNER reporting:
Scandinavian researchers convinced about 700 men with localized prostate cancer to let doctors make the decision between watchful waiting and prostate removal. Previously these researchers reported that after six years, radical prostatectomy reduced the risk of death from prostate cancer. But surgery can take a toll, too, and they couldn't tell if men who had the operation actually lived longer. Now they know. Study author Anna Bill-Axelson.
Ms. ANNA BILL-AXELSON (Study Author): Our study showed for the first time that radical prostatectomy reduces overall mortality.
SILBERNER: They calculate that after 10 years, 27 percent of men who have their prostates removed die from any cause compared to 32 percent of men who try watchful waiting. Urologist Bill-Axelson says the difference is primarily in men under the age of 65. Surgery didn't give much of an advantage to men over that age.
A study published last week in the Journal of the American Medical Association by Peter Albertsen and others seems to have a contradictory finding. Albertsen reported that watchful waiting is just as good as surgery. But Sweden's Bill-Axelson doesn't see it as a different message.
Ms. BILL-AXELSON: But our study is not contradicting Albertsen's at all.
SILBERNER: That's because last week's study dealt with men with very early stage cancer, found even earlier than a prostate blood test would necessarily reveal. Bill-Axelson agrees that surgery isn't as reasonable an option for men whose cancers are detected that early. The problem with predicting prostate cancer's course is that many factors can affect how aggressive it is: age, status of the cancer's diagnosis, race and other factors yet to be determined.
Internist Harold Sox, who now edits the Annals of Internal Medicine, is active in a movement to involve patients in decisions about their own care. He says what makes the prostate cancer surgery decision so difficult is not the prospect of surgery itself but the side effects when nerve-sparing surgery can't be done or is not available.
Mr. HAROLD SOX (Internist; Editor, Annals of Internal Medicine): And they mostly involve leakage of urine that can sometimes require the patient to wear a diaper all the time and sexual dysfunction, which takes the form of erectile dysfunction.
SILBERNER: That often doesn't respond to drug treatment. Sox says the reason there's not much information on the difference between radical prostatectomy and watchful waiting is the nature of the cancer itself.
Mr. SOX: Prostate cancer's a very slow-growing tumor, so that it takes a real long study in order to accumulate enough deaths to form statistically strong conclusions about differences in death rates.
SILBERNER: Finding people to enroll in studies is also tough. In the US, the tendency is to insist on surgery. In Scandinavia, men prefer to wait. There's another key question with prostate cancer: whether screening men to catch the cancer early helps. Sox says the new study may make doctors less likely to screen men over the age of 65 since it shows that surgical treatment in that age group doesn't make much of a difference. Joanne Silberner, NPR News.
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