Study shows early-stage prostate cancer surgery fails to cut death rate

Bloomberg News reports, “Surgery for prostate cancer was no better in saving lives than observation over a 10-year period, according to one of the first rigorous studies to compare the two approaches in American men with early-stage disease.”

The results, published in the New England Journal of Medicine, show that 10 years after early removal of the prostate gland, “47 percent of men in the surgery group had died, mostly from other diseases, versus 49.9 percent who were just watched.”

The Los Angeles Times says the study, “which focused on cancers still confined to the prostate, should reassure patients who want to avoid distressing side effects of surgery – such as urinary incontinence and sexual dysfunction – but still protect their lives, cancer experts said. If embraced by patients and doctors, the new information stands to radically change prostate cancer management in the US, where the majority of early prostate cancers are treated aggressively with surgery or radiation therapy.”

The New York Times “Well” blog reports says the study “included only men with early-stage disease, about half of whom learned of their cancer as a result of the prostate specific antigen, or PSA.”

The St. Paul Pioneer-Press reports, “The study suggested that a subset of men with intermediate-risk or high-risk tumors might fare better in terms of all-cause mortality with surgical treatment; the same goes for men with a prostate-specific antigen (PSA) screening score above a certain level.” However, “the study also found that adverse events within 30 days of surgery occurred in 21.4 percent of men, including one death.”

In a front-page story, the Boston Globe reports, “The clinical trial, performed at Massachusetts General Hospital and elsewhere, could be a turning point, shifting doctors toward more conservative treatment of men who are diagnosed with prostate cancer that has not spread beyond the gland, the authors said.”

The Chicago Sun-Times reports, “Lead author Dr. Timothy J. Wilt said his study adds to a growing body of evidence that supports active observation, particularly among men whose prostate-specific antigen (PSA) is 10 or lower – which means they are at low risk.”

The NPR “Shots” blog reports, “An accompanying editorial pointed out some shortcomings in the study, including the fact that about one-fifth of men didn’t stay in their assigned group. But it notes that the results from” this study “and some other trials show ‘that a national focus on PSA screening and treatment for prostate cancer may have a marginal benefit on the lifespan of men but at a considerable cost.'”

WebMD reports that “studies show that radical prostatectomy procedures are becoming more common. A study published in June in the Journal of Urology, for example, found the number of radical prostatectomies roughly doubled in the US between 2004 and 2010.”

Meanwhile, HealthDay points out that “in May, the US Preventive Services Task Force recommended against PSA-based screening for prostate cancer. The task force said there is a very small benefit to the test and significant harms.”

However, “other expert groups, most recently the American Society of Clinical Oncology, continue to recommend the tests, at least for those with a life expectancy of 10 years or more.”

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