The study of more than 1,600 men, published in the New England Journal of Medicine, is the first to randomly assign men to either “active monitoring” (wait and watch), surgery to remove the prostate or radiation, and then compare the results. After 10 years, the survival rate for each of the three groups was the same — 99 percent.
“That is a really striking finding: All three groups have almost 100 percent surviving. That should give all men pause before pursuing radical treatment for low- or intermediate-risk tumors,” Mark Litwin, M.D., chair of urology at the David Geffen School of Medicine at UCLA, who was not involved in the research, told Stat News.com.
The researchers from the universities of Oxford and Bristol noted that while treatment didn’t extend life during the first 10 years, further study with a longer follow-up (15 to 20 years) might find that men who are treated do live longer.
The study also found that surgery and radiation can cause sometimes severe side effects, including urinary and bowel problems and impotence, that negatively affected patients’ quality of life. Some of these effects gradually improved, the scientists reported.
Men need to consider the trade-off between these side effects and the higher risks of the cancer progressing, the researchers wrote.
Peter Scardino, a prostate surgeon and chairman of the department of surgery at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study, said the study helps confirm that active monitoring — regular testing and treatment if the disease progresses — is an appropriate approach for many men.
But, as he told the New York Times, monitoring must be done regularly for the rest of a patient’s life. “An important message from the study is that early prostate cancer is not an emergency and men have time to decide what to do about it.”
The study also found:
- Those who were assigned to the monitoring group were twice as likely to have the disease spread, although the numbers were low: Of 545 men receiving monitoring, the disease spread in 33, compared to 13 in the 553 who had their prostate removed, and 16 in the 545 who had radiation therapy.
- Men age 65 and older were slightly more likely to die from prostate cancer if assigned to monitoring instead of treatment, possibly because their cancer was more advanced than initially diagnosed, according to an accompanying editorial.
- Nearly half (46 percent) of men who had their prostate removed were using adult diapers in the first six months due to incontinence, although that dropped to 17 percent by six years out. Only 4 percent in the monitoring group and 5 percent in the radiation group needed absorbent pads.
- Only 12 percent of men who got surgery and 22 percent who had radiation could sustain an erection in the first six months, compared to 52 percent of the monitoring group. Erectile function remained the worst in the surgery group throughout the follow-up, although there was some improvement.