Some prostate cancer treatments may not be helping
OXFORD – It’s a diagnosis that many men dread, bringing with it fears of surgery and radiotherapy, possibly leading to life-changing complications. But a new study suggests that simply monitoring prostate cancer results in the same 10-year survival rate as treating it.
BBC News reports that UK researchers have warned that too many men were having procedures that damaged their sex lives and caused incontinence.
A trial of 1,643 men with small prostate cancers resulted in the same 99 percent survival rate after a decade for those who had had surgery, radiotherapy or simply monitored the tumour.
In the trial, men whose prostate cancer had been detected by testing for a chemical – prostate-specific antigen (PSA) – in the blood, were either monitored, had surgery to remove the prostate or radiotherapy to kill the tumour.
The study, which was backed by the National Institute for Health Research, then followed the men for 10 years.
While survival rates were found to be the same, there was a significantly higher risk of side-effects with treatment.
In those who had surgery, there was double the risk of incontinence and problems with sex. Radiotherapy increased the risk of bowel problems.
“It’s a global problem that patients are over-treated,” Professor Freddie Hamdy from the University of Oxford, told the BBC.
“It’s understandable, if a 55-year-old man is told they have cancer, and they have a family, they don’t want to take any risks.”
And the surveillance option did carry a risk of its own: the prostate cancer progressed in one in five cases.
While these men could be treated, it could affect their long-term survival beyond the 10-year study.
“At the moment, many men decide against active surveillance because of the uncertainty about the impact of that choice and the anxiety it causes,” Dr Matthew Hobbs, from the charity Prostate Cancer UK, told the BBC.
“It is extremely reassuring to hear that, when it is performed to a high standard, active surveillance gives men the same chance of survival.”
Professor Jenny Donovan, from the University of Bristol, noted that this was the first time radiotherapy, surgery and active monitoring treatments for prostate cancer have been compared directly.
“Each treatment has different impacts and effects, and we need longer follow-up to see how those balance out over the next 10 years,” she said.
The findings of the study, which were published in the New England Journal of Medicine, apply only to early stage tumours. Those found at a more advanced stage would be treated aggressively.