Surgery or Wait—the Latest and Greatest Study

It’s all about survival…

The results of an 18 year Swedish study were presented in the March 4, 2014 edition of The New England Journal of Medicine. 695 men from Sweden, Finland, and Iceland who were diagnosed with early stage prostate cancer between 1989 and 1999 were randomly divided into two groups. One group was to have radical prostatectomy and the other group was assigned to ‘watch and wait.’

In 2012, 23 years after the study began, the results were compiled. I will list actual numbers instead of statistical notations. You can read the NEJM article for more detailed statistical results.

Group 1. Men who had surgical prostate removal had a better survival rate.

Of the 347 men in that group, 200 had died by 2012 of all causes. 62 of that 200 had died from prostate cancer. The prostate cancer death rate was more than a third lower than in the ‘watch and wait’ group.

Group 2. Men in the ‘watch and wait’ group had a lower survival rate.

Of the 348 men in that group, 247 had died by 2012 from all causes. 99 of that 247 had died from prostate cancer.

Other Information

•   Men diagnosed and treated (group 1) before age 65 had the best survival rate. Men diagnosed and treated after age 65 had a survival rate no better than the ‘watch and wait’ group.        
• All men in the study were diagnosed using methods other than the PSA test. It was not readily available when the research began. Had PSA testing been available and used, it might have altered the outcomes.
•   Overall, prostate cancer death rates have dropped in the U.S.
•   The results of this study contradict the results of some earlier studies.
•     Men in the ‘watch and wait’ group whose cancer became more aggressive during the study were given needed treatment.

Bottom Line

Does this mean you should automatically have surgery if you are diagnosed? Of course not. Does this mean that ‘watch and wait’ is not effective? Of course not. Each individual diagnosis requires careful medical study, doctor-patient discussion, and an ultimate decision that best serves the patient. The Swedish study does show that in the case of this specific research population radical prostatectomy provided a better survival outcome.

If you are diagnosed, talk to your doctor, do your homework, and make the decision that seems right for you.

axman