Is Surgery Necessary for Prostate Cancer?

By Sara Bondell - December 18, 2018

A 30-year study found that prostate-removal surgery added three years to the lives of men with prostate cancer, compared to those who were only monitored.

While the results suggest surgery may be the best choice for men with advanced prostate cancer, men with slow-moving cancer in the early stages may want to think twice before jumping on the operating table.

The study’s findings are complicated, and Dr. Julio Pow-Sang, chair of Moffitt’s Genitourinary Oncology Program, says the patients involved in the study are not like the ones commonly seen today.

When the study began in the late 1980’s, there was no prostate specific antigen (PSA) test. PSA tests can spot tumors earlier, which gives the patient more treatment options. Those options have also changed in the last three decades. Instead of the “watchful waiting” referenced in the study, patients with low-risk disease can now choose active surveillance.

Dr. Julio Pow-Sang, chair, Genitourinary Oncology Program at Moffitt Cancer Center.

“Watchful waiting does not offer treatment right away if the cancer gives no symptoms,” Dr. Pow-Sang said. “Active surveillance means closely monitoring very early, slow growing cancer and treating with surgery or radiation if the cancer turns active.”

The trial involved about 700 men in Sweden, Finland and Iceland. Over 23 years, there were 45 percent fewer prostate-related deaths in men who got radical surgery. However, almost 70 percent of the men in the trial died from other causes, which suggests low-risk tumors do not need immediate treatment. 

The National Comprehensive Cancer Network guidelines recommend active surveillance for patients with very low risk and low risk disease who have a life expectancy less than 20 years and 10 years, respectively. Active surveillance typically involves PSA testing every six months and digital rectal examination every year.

In addition, the 2016 ProtecT Trial concluded at an average of 10 years after diagnosis, the mortality rate was almost the same in patients who were treated with surgery, radiation therapy or active surveillance.

Dr. Pow-Sang says while prostate cancer has a history of being overtreated, urologists are becoming more and more aware that active surveillance may be the best management option for men with very early cancer.

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