By Julia Medew SMH
July 20, 2012
A LANDMARK study of prostate cancer surgery has found it does not appear to save the lives of men with early-stage disease and causes high rates of incontinence and erectile dysfunction.
In what has been described by experts as ”game changing” research, American researchers tracked the progress of 731 men with prostate cancer over 12 years to see how surgical removal of the prostate compared with continuing observation of the cancer to see if it becomes more active or spreads.
The largest clinical trial comparing the two approaches to date found surgery did not significantly change the survival rate between the groups. After 10 years, 21 men or 5.8 per cent of those who received surgery had died from prostate cancer or its treatment, compared to 31 or 8.4 per cent of those whose doctors watched their progress.
However, in the surgery group, one in five men suffered a complication from the surgery called a radical prostatectomy. Two years on from the procedure, one man had died from it, 81 per cent suffered erectile dysfunction, 17 per cent had urinary incontinence and 12 per cent bowel dysfunction.
After two years of observation for the other group, 44 per cent had erectile dysfunction, 6 per cent urinary incontinence and 11 per cent bowel dysfunction.
The researchers concluded that for men with early-stage cancer that had not spread from the prostate, radical prostatectomy did not significantly reduce the chance of death over 12 years.
”Our findings add to evidence supporting observation, and possibly active surveillance, for most men who receive a diagnosis of localised prostate cancer, especially those with a low PSA [prostate-specific antigen] value or low-risk disease,” they wrote.
The findings, published in the New England Journal of Medicine, add to growing concern that the use of unreliable PSA tests is causing ”overdiagnosis” of prostate cancer, which in most men will be so slow growing, it will not cause them harm.
In Australia, doctors say about 20,000 men are diagnosed with prostate cancer each year, including one in six with an aggressive form. However, because it is difficult to tell which of the remaining cancers will progress to cause trouble or not, many men are choosing treatments that can cause them harm, including thousands who decide on surgery.
The chief executive of the Cancer Council, Ian Olver, said the largest study of PSA testing in Europe had shown that for every man whose life was saved by a radical prostatectomy, 37 men had one that did not save their life. ”I can’t imagine the figure is any different in a … country like Australia,” he said.
”The whole problem is selecting the ones which need to be operated on.”
However, Professor Olver said surgery was still likely to help men diagnosed with aggressive prostate cancer.
A cancer specialist, Ian Haines, said the study showed doctors needed to fully brief patients on the risks of getting PSA tests if they were to provide truly informed consent.
”To do otherwise would constitute suboptimal care and may create a legal risk for the practitioners involved,” he said.