MINNEAPOLIS — The largest and longest trial to compare treatment options for men with prostate cancer has found little difference in outcomes between men who underwent surgery vs. those who were simply observed by their doctors.
Led by a researcher at the Minneapolis VA Medical Center, the 20-year national study provides the best evidence yet that most men can live with prostate cancers, avoiding the potential risks of surgery. The results, though, did show that surgery was probably a better option for younger men with long life expectancies — and some urologists dispute the findings.
“Our results demonstrate that for the large majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer, and prevent harms from surgical treatment,” said Dr. Timothy Wilt, an internist at the Minneapolis VA who led the study. A decade ago, doctors often recommended surgery or radiation to remove prostate cancers but the results suggest a more conservative course.
Dr. Christopher Knoedler of Metro Urology in the Twin Cities said about one-third of patients in his practice with prostate cancer undergo observation. He remains a strong advocate for regular prostate screenings and still offers prostate removal surgery to most patients, but said he will use the study’s findings in discussions with patients who might not need surgery.
“Some patients get that C word and they want to be treated,” Knoedler said, “but they don’t always need to be treated.”
More than 700 men with prostate cancer were randomly assigned between 1994 and 2002 to two treatment groups, and researchers then monitored their progress.
Because prostate cancer is commonly found in older men, most research participants died during course of the study. But prostate cancer was the cause of death in only 27 men who underwent surgery and 42 men whose cancers were monitored by doctors — a statistically negligible difference, the study concluded.
Avoiding surgery means avoiding some of the potential complications, including incontinence and sexual dysfunction. These problems were more common in the men who underwent surgery, according to the results, published Thursday in the New England Journal of Medicine.
Surgery was associated with a lower death rate in men whose prostate cancers presented intermediate risks, but not for the cancers that presented the lowest or, surprisingly, with the highest risks. Wilt said surgery may still be the best option for men with long life expectancies.
The findings are likely to draw objections from some urologists, who bristled in 2012 when the U.S. Preventive Services Task Force recommended against routine use of prostate-specific antigen blood screenings for prostate cancer in men. (The task force has since stated that men between the ages of 55 and 69 should consult with their doctors about PSA screening.)
Urologists note that, because of improved surgical techniques, complications that might have been common at the time men in the study underwent surgery are less likely today.