Surgery May Be Best for Prostate Patients

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For men with prostate cancer, surgery may offer a better chance for survival than other standard treatments, such as watchful waiting, radiation or hormone therapy, a new study suggests. The survival benefits of surgery, the study found, may be most profound over the long term and in men who are diagnosed with cancer at a relatively young age.

In the study, published in the Oct. 8 issue of the Archives of Internal Medicine, researchers at Geneva University in Switzerland reviewed the medical records of 844 patients diagnosed with localized, early-stage prostate cancer between 1989 and 1998: 158 patients received prostatectomy, or surgical removal of all or part of the walnut-sized prostate gland; 205 underwent radiation, either alone or in conjunction with hormone therapy; 72 got hormone therapy alone; 378 were managed with watchful waiting, which entails monitoring disease progression and pursuing treatment if the condition worsens; and 31 were given other treatment combinations.

Five years after diagnosis, survival rates among the patients were similar, regardless of the kind of treatment they received. But in the long term, after 10 years, the cancer-specific survival rate was significantly higher in the surgery group — 83% — than in patients who received radiation (75%) or watchful waiting (72%). The study's data also suggest that younger patients, under 70, and patients with aggressive cancer tumors — those with so-called Gleason scores of 7 or above — had a more significant survival benefit from surgery than other patients. On average, says Dr. Elisabetta Rapiti, a co-author of the study, "at 10 years, patients, all ages considered, who did not have surgery had a doubled risk of death from prostate cancer."

The authors of the current study say theirs is the first to examine long-term survival rates of standard prostate cancer treatments, but warn that the results are not definitive. Because the study was observational — rather than a randomized head-to-head comparison of the treatments — the data could have been biased by other factors, such as personal treatment preferences of patients and doctors and other confounding health problems. "It's a retrospective study. In that era, the patients who were the best candidates for treatment got surgery," says Dr. Patrick Walsh, author of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer and former director of the Brady Urological Institute at Johns Hopkins Hospital.

Whether or not surgery proves definitively to be more effective than other prostate cancer treatments — researchers won't know without further study — it's not without serious risks. "[It] has frequent adverse effects like impotence and urinary incontinence," Rapiti says. "For sexually inactive, older patients these repercussions may have lesser impact than in young, sexually active patients. Our study adds information on long-term survival but, unfortunately, not on quality of life."

The good news for men faced with the decision is that the risk of impotence is not nearly as high as it once was. "Twenty years ago, every man who had his prostate removed was impotent," Walsh says. But early detection and modern surgical techniques — such as nerve sparing methods pioneered by Walsh — have changed those odds tremendously. "Today, if a man is fully potent, his chances of being potent after surgery, done by a good surgeon, are 90%."