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

To PSA or NOT to PSA--A Man's Dilemma

...another controversial medical recommendation

Recently, the USPSTF (U.S. Preventive Services Task Force) published a recommendation against routine PSA screening for men of all ages. They cited numerous clinical studies (some inconclusive or contradictory) showing no statistical survival benefit for men getting regular prostate cancer screening with a PSA compared to those men who did not have a PSA screening.

Further, the report pointed out the risk of men having unneeded and risky treatments that could result in impotence, incontinence, infections, heart attacks, and other unpleasant side effects.

There is no way to determine from a PSA test whether a tumor is aggressive (life threatening) or slow growing (not life threatening). A biopsy can help determine the growth rate of a tumor but there is some risk of infection (albeit small) from that invasive procedure.

So, they contend, no screening is better for the 5 out of 6 men who are likely to never get prostate cancer. And of the 1 in 6 who will get prostate cancer some will have a slow growing type and will not need immediate treatment.

But what about those poor guys (like me) who have or will have an aggressive (life threatening) tumor in their prostate? Although statistically not significant, determining risk and getting treatment early would be really helpful‑‑maybe even life saving.

Maybe the problem is not with the PSA test, which can detect cancer, but with the decision making by doctors and patients after the test. Could this, perhaps, be an area for further study?

I have had and will continue to have PSA tests on a regular basis. I know a number of men who are being treated for an aggressive form of prostate cancer. To a man they are happy to have been diagnosed and treated and still be alive. Me, too. We do not believe that our lives are not significant. The discussion is not over. There must be a better solution!

axman