Surgery improves survival for prostate cancer patients
Publication Date:10/10/2007
Men who have an operation to remove prostate cancer are twice as likely to be alive 10 years later as those who have other treatments for this illness, according to a new study. Men under the age of 70, and those with cancers that show signs of spreading, are most likely to benefit from surgery.
What do we know already?
Cancer of the prostate is the most common cancer affecting men in the UK. Around 32,000 men find out they have prostate cancer each year. Prostate cancer usually grows slowly. This means you can live for years without symptoms.
These are some of the ways doctors treat prostate cancer:
- Watchful waiting, when the doctor checks regularly to see if the cancer is growing. Patients only start active treatment if there are signs that the cancer is starting to spread
- Surgery, when a surgeon cuts out the cancer. There are several ways of doing this operation
- Radiotherapy, when the doctor targets the cancer with radioactive waves, to kill the cancer cells
- Hormone treatments, when the supply of male hormones to the prostate gland is stopped. This may stop the cancer from growing.
The problem is that doctors still don't know enough about whether the treatments available for prostate cancer will help you live longer. Surgery, radiotherapy and hormone treatments have side effects, which can have a big impact on men's lives. It's hard to choose between them.
Also, prostate cancer is complicated. Different cancers grow at different rates. Someone might have a slow-growing cancer that never gets big enough to cause problems. They might have prostate cancer for 20 years, then die of something else altogether. Another man might have a fast-growing cancer that spreads quickly.
Unfortunately, there's no sure way of knowing for sure whether a prostate cancer is likely to grow fast or slowly. Doctors and patients have to decide together which treatment is best for the individual patient.
Some studies have compared what happens to people who choose to have one type of treatment or another. But there are problems with doing this. For example, a man aged 60 might be more likely to have surgery, because he is fitter and better able to undergo an operation. A man aged 80 might be more likely to decide to wait and see what happens (watchful waiting). But then the younger man might live longer just because he is younger, not because the treatment works better.
What does the new study say?
The new study looked at what happened to 844 men in Geneva, Switzerland, who had been diagnosed with prostate cancer that had not spread. The researchers looked at what treatment the men had in the first six months after being diagnosed.
Men who had an operation to remove prostate cancer were more likely to be alive 10 years after being diagnosed, compared with men who had watchful waiting, radiotherapy or hormone treatments. The researchers say this was still true when you take into account the men's ages and the stage at which their cancer was diagnosed.
Tell me more about the study's findings
These are the figures from the study. Remember that they are just statistics based on the men in this study: they don't say what will happen to you if you have prostate cancer.
10 years after being diagnosed with prostate cancer:
- 69 percent of men who'd had surgery were still alive
- 54 percent of men who'd had radiotherapy were still alive
- 35 percent of men who'd had watchful waiting were still alive
- 18 percent of men who'd had hormone treatment were still alive
But these figures don't take into account the differences in age and other differences between the men that could affect the results. Taking these things into account, the researchers calculated that after 10 years:
- Men who'd had surgery were about twice as likely to be alive as men who had radiotherapy or watchful waiting
- Men who'd had surgery were about four times as likely to be alive as men who had hormone treatment
So the message from this study is that surgery does seem to give men a better chance of living longer, compared to other treatments.
The researchers looked to see if any particular groups of men benefited more than others. They found men under 70 were most likely to benefit from surgery. That's because younger men are more likely to live at least another 10 years if they have effective treatment. Older men may not live any longer than they would have done without treatment.
Also, men with cancers that already show signs of spreading were more likely to benefit. That may be because these cancers are more likely to grow faster, and so increase the risk of death, if they are not removed.
Where does the study come from?
The study was carried out by researchers at Geneva University in Switzerland, the National University of Singapore, Singapore, and the University of Turin, Italy. It was published in a US medical journal called the Archives of Internal Medicine, which is published by the American Medical Association.
How reliable are the findings?
The researchers looked at quite a big group of men, and took a lot of care to make their findings as reliable as possible. However, it's possible that they were not able to take account of all the things that might have made a difference to the results. We need bigger, better-designed studies to answer these questions properly.
What does this mean for me?
If you have prostate cancer, it's hard to know what type of treatment to have. This study gives you some more information that may help. You can discuss the results with your doctor, and perhaps with family members. Your doctor may be able to tell you whether your cancer shows signs of spreading.
Length of life is not the only thing to think about, when you are considering treatment. All treatments have side effects, which can include erection problems and incontinence. Many people want to know about how prostate cancer treatments will affect their ability to get on with their everyday life. Make sure you ask your doctor about how treatment will affect you.
Finally, the study was done looking at the results of men who were treated 10 years ago. Treatments may have improved since these men were diagnosed with cancer. In fact, there are some treatments available today that nobody in the study had: for example, a type of radiotherapy called brachytherapy. This study doesn't tell us about how today's treatments compare with surgery.
What should I do now?
If you have prostate cancer and you're considering treatment, you could talk to your doctor about these results. They may help you decide which treatment is right for you.
To help you make this decision, you may need to ask yourself:
- Would I be too worried to live with an untreated cancer, if I chose watchful waiting?
- What effect would erection problems and incontinence have on my life?
- Am I fit and healthy enough to have surgery?
- Does my age make a difference to my decision?
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
