Men stricken with prostate cancer before the age of 65 often might be better off undergoing surgery to remove the prostate gland rather than waiting to see how the disease develops.
As the Associated Press reports, a study led by Swedish researchers has found that the so-called “watchful waiting” approach — which calls for holding off on surgery and other therapies unless doctors determine that a cancer is aggressive — leads to a lower survival rate among younger prostrate cancer patients.
The study, published in the New England Journal of Medicine and one of the longest-running investigations into prostate cancer treatment, tracked 695 Swedish men with the disease starting in 1989. The group was divided into those whose treatment was based on immediate surgery, and patients who waited and monitored the progress of the cancer.
The researchers found that, over 15 years, 14.6 percent in the immediate surgery group died of prostate cancer, versus 20.7 percent, of those in the watchful waiting group. The patients in the watchful waiting group also were more likely to see their cancer spread to other parts of the body, requiring additional treatment.
The better survival rate among the surgery group, however, was associated only with patients under age 65.
In an editorial accompanying the study, Massachusetts General Hospital’s Dr. Matthew R. Smith wrote that the research “has provided important evidence that effective treatment is both necessary and possible for many men with early-stage prostate cancer.”
However, there are questions about what the study’s results mean for U.S. patients. In Sweden, prostate cancer is typically isn’t detected until symptoms of the disease emerge.
In the U.S., the widely used PSA blood test often discovers the cancer long before any symptoms appear, and the disease commonly is treated aggressively in younger patients with radiation, hormones or surgery.
Ongoing research in the U.S. and the United Kingdom is looking into whether surgery has the same advantages for patients whose cancer was detected with a blood test.
Surgery also has some significant drawbacks; 58 percent of those patients in the Swedish study reported sexual side effects, and another 32 percent had problems urinating.
For older men, doctors are much more apt to recommend less aggressive treatment for prostate cancer because it generally is so slow-growing. In fact, the as The New York Times reported, U.S. Preventive Services Task Force recently concluded that screening for the disease should stop when men reach age 75.
Separately, as Reuters reports, Canadian researchers have found that three nutritional supplements once hoped to help stave off prostate cancer — vitamin E, selenium, and soy — showed no benefits among men at higher risk for the disease. The new study, published in the Journal of Clinical Oncology, tracked men who took the supplements daily for three years.
