Prostate Cancer Surgery Shows No Benefit For Many Men

hopeful and optimistic

July 18, 2012
View and comment on NPR.org
Finally, the results from a decades-long study that compared surgery for prostate cancer to careful monitoring have been published.
Overall, the researchers found no difference in rates of death from any cause, including prostate cancer, among men who had their prostates surgically removed compared to those who didn't.

Preliminary results were released more than a year ago.

The newly published conclusion:

"Our findings support observation for men with localized prostate cancer, especially those who have a low PSA value and those who have low-risk disease. Up to two thirds of men who have received a diagnosis of prostate cancer have a low PSA value or low-risk disease, but nearly 90% receive early intervention — typically surgery or radiotherapy."

The findings appear in the latest issue of the New England Journal of Medicine.

IN 2011, Dr. Timothy Wilt, the lead author on the paper, presented findings from the study, called PIVOT for short, at a meeting of urologists in Washington. Thousands of doctors, many of whom routinely perform prostate surgery, sat silent as the evidence suggested that waiting was a reasonable choice for men whose cancer hadn't spread and appeared to be a low risk to their health.

The federally funded PIVOT study looked at the health of 731 men diagnosed with prostate cancer between 1994 and 2002. They were randomly assigned to have their prostates surgically removed or to be observed. After follow-up of about 10 years, a little fewer than half of the men in each group had died.

Now that the data have been subjected to peer review and have been published in an influential journal, they may get even more attention.

"Overtreatment of prostate cancer is a well-recognized phenomenon," Dr. Durado Brooks, of the American Cancer Society, said in a statement about the paper. "Observational management has been recommended for some men for over a decade, yet 9 out of 10 U.S. men diagnosed with prostate cancer continue to receive definitive therapy (usually surgery or radiation)."

Prostate surgery has risks and side effects, including incontinence and impotence.

The PIVOT results may help give doctors and patients more confidence that waiting can be OK, he said. "Some 30 to 40 percent of men diagnosed with prostate may be candidates for observation, many men have never heard of observational management and are never informed that this may be a reasonable option for them."

Some doctors have already gotten the message. "For my practice it's not going to change much," urologist Benjamin Davies, a cancer specialist at the University of Pittsburgh med school, told Shots. The PIVOT results "confirm our suspicions that treating low-risk prostate cancer in older men is not helpful."

In his reading of the study, there is a survival benefit for patients with high-risk cancers. For men whose PSA results were greater than 10 and who had surgery, the rate of death from any cause was lower than for men with similar PSAs who didn't have surgery.

An accompanying editorial pointed out some shortcomings in the study, including the fact that about one-fifth of men didn't stay in their assigned group. But it notes that the results from PIVOT and some other trials show "that a national focus on PSA screening and treatment for prostate cancer may have a marginal benefit on the lifespan of men but at a considerable cost."

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

VascodaGama

Flip a coin
We could flip a coin and get an opposite opinion on the study's conclusion. I think that a considerable number of patients have benefited from surgery too.
Nevertheless, I would opt for a conclusion based on quality of life Vz quantity.

Here are opinions of some members of this forum regarding a similar thread with origins on the same study;
http://csn.cancer.org/node/239854

Best
VG

Samsungtech1

VascodaGama said:

Flip a coin
We could flip a coin and get an opposite opinion on the study's conclusion. I think that a considerable number of patients have benefited from surgery too.
Nevertheless, I would opt for a conclusion based on quality of life Vz quantity.

Here are opinions of some members of this forum regarding a similar thread with origins on the same study;
http://csn.cancer.org/node/239854

Best
VG

Study
To all,
I read this report three times because it is really confusing. I believe it said that 5.7 per cent of the test group, 731 men and I would guess split in half, 8.7 per cent of the watchful waiting group died compared to 5.7 of surgery patients. It seems to me that the main point they were stressing was incontinence and ed. There is where the big difference was. Of couse that would make sense without a study. We could have told them that.

Bottom line is more men died on watchful waiting than on R P. but they had more sex before they died. It does not say this bit if you read this study it is
Really hard to figure outwhat they are saying.

This was one of the worse studies I have ever read. Mindboggling.

Mike

ob66

Article
The way I read this article is very carefully; and between the lines. I found it most interesting that one urologist said it would not change much in the way he already practiced. My guess is that he tends to watch wait those patients with very low numbers, and treats those with high numbers. Duh, sounds reasonable to me. As does the concept that there is probably a lot of over treatment.

Notice the numbers---two thirds of the population with low risk tendencies treat to the extent of 90%. Now this may not all be physician choice, for I know many people who when diagnosed with Cancer just want it out of there. Even if two thirds of the low risk population treated at a 67% rate I could see a case for over treatment--they should be treated at a rate below that---maybe not zero, but low, for you have some that will insist on treatment no matter what.

The thing that one must be careful of, is that with increased coverage medically in a population base, the filters must go on to keep costs down. Makes sense to me. Also, a bit difficult to swallow if you are the "victim" or "diagnosee" when your wishes may conflict with the numbers. I really don't see where the article says you should not treat prostate cancer surgically, but be careful and fully aware of the numbers as to when to treat and when not to treat. This is a way that "public health" type agencies can restrict treatment, so be careful, study, and make an informed decision for yourself.