Prostate Surgery: For Older Men, Waiting May Be Better

For men in their 60s who are diagnosed with early-state prostate cancer, surgery doesn’t help them live significantly longer than those who wait and monitor the slow-growing disease, a landmark new study finds.

Prostate cancer affects one in six men, but surgery often causes serious side effects, including urinary incontinence and sexual dysfunction.

The results of the federally funded study suggests that a more conservative approach might be better, especially for men with a PSA reading under 10 ng per millileter and tumors that haven’t spread beyond the prostate gland.

The decades-long trial, published in the latest issue of the New England Journal of Medicine, involved 731 men (average age 67), who were diagnosed with early-stage prostate cancer detected via PSA screening, rectal exams, and biopsies. About half were randomly selected to have their prostate removed immediately, while the rest were monitored by doctors to see whether their cancer began to progress.

During the 12-year follow-up, the death rate from prostate cancer or as a result of surgery to treat it was about the same in both groups — approximately 7 percent.

However, surgery did appear to benefit a small group of men who had PSA readings higher than 10 ng. per millileter, larger tumors,  or abnormally-shaped tumor cells.

For high-risk men, “surgery clearly has been shown to be beneficial over watchful waiting,” study co-author William Aronson, a urologist at the  VA Greater Los Angeles Healthcare System, told the Los Angeles Times.

Some cancer specialists, however, pointed out that the study’s findings don’t apply to men in their 50s, who will still likely opt for immediate surgery. Only 10 percent of the men in the study were under age 60.

“We can’t conclude from the study data that a healthy 50-year-old man with low-risk disease should skip treatment because the follow-up isn’t long enough to determine whether his disease will progress,” Anthony D’Amico, M.D., chief of genitourinary radiation oncology at Brigham and Women’s Hospital., told the Boston Globe.

The study also found:

*Men who had surgery had more side effects. About 17 percent had urinary incontinence, compared to 6 percent of those in the non-surgery group, while 81 percent in the surgery group had erectile dysfunction, compared with 44 percent of those who were monitored.

*Surgery benefited men with higher PSA readings. Men in the study who had PSA levels greater than 10 ng per millimeter had a 33 percent lower risk of dying from prostate cancer if they were immediately treated with surgery rather than waiting and being monitorederved, a statistically significant difference.

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