Skip to main content
Part of complete coverage on

Prostate surgery comes out slightly ahead of 'watchful waiting' in new study

By Caleb Hellerman, CNN
updated 8:27 AM EST, Thu March 6, 2014
Aggressive surgery can save lives and lead to a better quality of life for prostate cancer cases, a new study says.
Aggressive surgery can save lives and lead to a better quality of life for prostate cancer cases, a new study says.
STORY HIGHLIGHTS
  • Men who had prostate surgery had better quality of life, new study finds
  • Overall, though, "watchful waiting" for prostate cancer is still recommended
  • "We may undertreat those with high-risk cancers," doctor says of study
  • Findings could reignite debate over best treatments for prostate cancer

Vital Signs is a monthly program bringing viewers health stories from around the world, giving a global perspective on how health issues are detected, treated and handled socially.

(CNN) -- When it comes to prostate cancer, aggressive surgery saves lives and leads to a better quality of life, according to a new study that could inflame the debate over how best to treat the disease -- and in some cases, whether to treat it at all.

The paper, published in the New England Journal of Medicine, is an update on a study that was launched in Sweden, Finland and Iceland a quarter-century ago. Nearly 700 men newly diagnosed with prostate cancer were split into two groups: half had their prostate gland fully removed -- a radical prostatectomy -- and half were followed through a protocol of "watchful waiting," where doctors only treated them if symptoms progressed.

On average, men who underwent immediate surgery lived longer, were less likely to see the cancer spread and had fewer complications from the disease. The longevity benefit was greatest for men in their 50s and early 60s, where over an 18-year period, surgery cut the death rate by more than a third.

That result might seem obvious, but watchful waiting is frequently recommended because of surgery's side effects and because most prostate cancers grow so slowly that men will die of other causes before the cancer can kill them.

Dr. Drew: 'I am a cancer survivor'
Reporter puts face on health care debate
New cancer screening guidelines issued

Hold the salmon: Omega-3 fatty acids linked to higher risk of cancer

The new study is likely to give pause to some of those patients.

"Our research suggests that we overtreat many men," says Dr. Peter Carroll, chairman of urology at the University of California, San Francisco. "But at the same time, we may undertreat those with high-risk cancers."

The authors of the new paper say they aren't looking to overturn current guidelines that recommend active surveillance -- waiting, with regular testing to see if the cancer has progressed -- in men with low-risk disease. "The numbers in each subgroup are low, and the risk categorization is less sophisticated than current standards," they wrote, urging caution in interpreting the results.

Dr. Otis Brawley, medical director of the American Cancer Society, says the paper generally supports current practice. He notes that patients in the Swedish study likely had more aggressive disease to start with because they were diagnosed after complaining of symptoms.

According to Brawley, just 12 percent of U.S. prostate cancer patients are found because they show symptoms; the rest are identified through PSA tests and other screening.

"Those guys with high-grade tumors, those are the guys we ought to be treating," Brawley says. He notes that other studies, including the highly regarded PIVOT trial, have found even fewer benefits from surgery. "They all say the same thing, that radical prostatectomy for men 65 and above seems not to save lives."

But others are struck by the finding that all groups in the study, even men over 65, suffered fewer side effects when they initially opted for surgery. "This drills down that it's not all about mortality," says Dr. John Davis, director of the prostate surgery program at MD Anderson Cancer Center in Houston.

More lives being saved: Cancer death rates drop 20%

Davis explains that many patients who choose a regimen of watchful waiting or its close cousin, "active surveillance," eventually undergo repeated biopsies, radiation therapy or other measures.

"I would argue that the side effects of surgery are much less than those of long-term hormone therapy," which reduces the level of hormones like testosterone that promote the growth of prostate cancer.

While surgery often leads to sexual dysfunction and/or urinary incontinence, hormone therapy has its own dangers, including low sex drive, hot flashes, loss of energy, weight gain and an increased risk of heart disease.

Carroll agrees that mortality is only part of the picture and says the new study underscores a need to better differentiate between high- and low-risk cancers.

"Although it is often said that there is little benefit (from surgery) to those over 65, this appears not to be the case. It's more a function of the aggressiveness of the tumor and the health of the patient."

ADVERTISEMENT
Part of complete coverage on
updated 6:02 AM EDT, Thu April 24, 2014
A device for extracting water from air is being used by the military -- could it help developing countries too?
updated 5:31 AM EDT, Fri May 23, 2014
Air-cleaning pavillion to be launched at the 2015 Milan Expo
Air pollution is now the biggest global environmental killer, but these high-tech solutions could save lives.
updated 3:54 PM EDT, Mon April 14, 2014
robohand metal hand
A South African carpenter lost his fingers in an accident -- now he's making mechanical fingers and hands for others.
updated 8:16 AM EDT, Thu August 7, 2014
Connie Culp was injured when her husband shot her in 2004. She underwent a near-total face transplant at the Cleveland Clinic in 2008 -- the first operation of its kind in the United States
As face transplants become more common, hospitals may soon be asking: Will you donate your face?
updated 1:18 PM EDT, Wed May 28, 2014
TB is growing increasingly drug resistant -- and it's becoming a global problem.
updated 8:49 AM EDT, Thu August 14, 2014
A 10-year-old inventor and a 20-year-old MD? Meet the whiz kids changing the face of medicine.
updated 6:27 AM EDT, Fri May 9, 2014
A Southern Sudanese man uses a pipe filter to protect himself from Guinea worm disease while drinking water from a potentially infected source. The pipe filter strains out the water fleas that can contain Guinea worm larvae.
Guinea worm disease once infected millions -- now it's almost eradicated. But can we catch the final cases?
updated 6:46 AM EDT, Thu September 4, 2014
A staff member from the Environment & Animal Society of Taiwan, a non-profit organisation based in Taipei, points at the part of a horseshoe crab where blood is drawn for use in laboratory tests against animals, during a press conference in Taipei on December 4, 2012.
Hundreds of thousands of horseshoe crabs are captured each year for their incredible blue blood. Here's why.
updated 7:27 AM EDT, Fri September 12, 2014
Lika Rose Caticon, 7, who is suffering from Typhoid fever, holds a doll as she lies in a makeshift cot at the overcrowded JP Rizal Memorial District Hospital in Calamba City south of the Philippine capital Manila on March 5, 2008.
As we travel ever further afield, which infectious diseases do you need to know about?
vital signs logo
Vital Signs is a monthly program bringing viewers health stories from around the world.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT