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Prostate cancer surgery fails to cut deaths in study

NEW YORK (Reuters Health) – Prostate cancer surgery didn’t appear to save lives compared with observation alone in a new study that tracked men for a decade after their diagnosis.

However, nearly twice as many men who had surgery reported incontinence and impotence after two years, researchers report July 18 in the New England Journal of Medicine.

“These are very compelling data,” said Dr. Durado Brooks, director of prostate and colorectal cancers at the American Cancer Society, who was not involved in the research.

Both he and study author Dr. Timothy Wilt of the University of Minnesota School of Medicine said the results suggest that many men who have received surgery in the past probably didn’t need it.

“I don’t think there’s any question that many of those cancers were overtreated,” said Dr. Brooks.

The new study is based on 731 men who had been diagnosed with prostate cancer, often as a result of screening with the prostate-specific antigen (PSA) test. Researchers then randomly assigned the men to prostate removal or observation only.

More than a decade after the tumor was discovered, 5.8% of the men who received surgery had died from prostate cancer or its treatment, compared to 8.4% of patients who were just observed. Overall, 47% of the men in the surgery group died during the study, compared to 50% of the others. Neither of those differences was statistically significant.

By contrast, more than one in five of the men who went under the knife experienced a complication of the surgery, including one death.

“Death from prostate cancer, with observation, was very uncommon,” Dr. Wilt told Reuters Health.

“We think our results apply to the vast majority of men diagnosed with prostate cancer today,” he said.

The study, which only dealt with localized tumors, leaves open the possibility that men with PSA levels greater than 10 nanograms per milliliter may still benefit from surgery.

The men were enrolled in the PIVOT — the Prostate Cancer Intervention Versus Observation Trial — between 1994 and 2002.

At the two-year mark, 17% of those who had undergone surgery reported urinary incontinence. The rate was 6% in the observation group. In addition, 81% of surgery patients had impotence problems compared with 44% in the observation group.

“My hope is that men will look at this information and try to make some decisions in a less emotional way,” said Dr. Brooks. “But the reality is, it usually takes 10 years for significant shifts in medical practice as a result of new findings in the medical literature. So it’s going to be a slow transition to get people to back away from this type of diagnosis.”


N Engl J Med, 2012.