Dr. Badani: Prostate Cancer Surgical Technique Provides Quicker Recovery



Prostate Cancer Surgery Saves Lives, But How Does a Man Decide?

What Research Shows About Radical Prostate Surgery

Only two well-done studies have been done in the last 25 years attempting to show the impact of  radical prostatectomy surgery.  One of the studies was done in Sweden, and new information on 23 years of follow-up offers both good and not-so-good information about this treatment. The good news is that surgery prevented one out of every eight men from dying of prostate cancer. The greatest benefit occurred in men under 65 and those with intermediate-risk disease; in the latter group, only four needed to be treated to prevent one cancer death.  In men with low-risk disease, surgery improved their overall survival and their need for hormone therapy, but so far it has not reduced their risk of dying from prostate cancer.

Unfortunately, surgery did not help men with high-risk disease, those with a PSA over 20 ng/ml or a Gleason score of 8 to 10. It also did not improve survival in men over 65, although it significantly reduced their risk of developing metastatic disease.

Watch-and-Wait or Go Under the Knife?

Many people want to know how this study impacts U.S. men, who are mostly diagnosed using the PSA test. A PSA test diagnoses cancer earlier than the tests used to diagnose most of the men in the Swedish study.  First, this means that it will take longer to assess the impact of treatment in the U.S. study, which so far has shown a trend toward benefit but only about 3 percent lower mortality. Second, it means that men with low-risk disease (PSA less than 10 ng/ml, Gleason 3+3, normal prostate exam) can still consider active surveillance rather than immediately select prostate cancer surgery, particularly those with a life expectancy of 15 years or less.

Managing prostate cancer continues to be a major challenge because, unlike other cancers,  it's one with more than 15 treatment options. Aside from the two studies discussed in this article, no valid comparisons have been done for the remaining options. That leaves tremendous uncertainty about their relative merits and subjects patients to potential biases of doctors recommending treatment. For those reasons, men with prostate cancer need to ask the right questions, do their own homework, share in the decision about what to do for their prostate cancer

Last Updated:3/17/2014
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Date: 06.12.2018, 22:06 / Views: 82295