If cancer was found at an early stage, men have choice to treat it immediately or to be monitored and submit to occasional test and later be treated if needed. One of the few studies comparing these options in men with tumors confined to the prostate showed that death rates were similar for both those who had immediate intervention and those who assigned to monitoring. Also it was revealed that surgery had more side effects.
One study leader and urology chief at Washington University in St. Louis, Missouri, Dr. Gerald Andriole said “Many men, when they hear the word cancer, you want to do something about it,” adding, “The reality is, if you have a low-risk cancer, like the study shows, you don’t need treatment, certainly not urgently.”
Early stage doesn’t always mean low risk, there are some results in the study that showed surgery has some advantages. For some groups surgery is even more helpful in the early stage.
One of the facts that is really hard to accept is that some cancer should not be killed. Some prostate tumors are very dangerous and are deadly, but most of them grow in a very slow paste that men will probably die of some other cause.
Sometimes treatments harm can more than disease. For example surgery, radiation or hormone therapy can cause impotence, incontinence, infections etc.
Despite many’s believes monitoring does not mean doing nothing. It includes tests, and technology advanced so now we have better ways of detecting progression of the disease, so there is still a chance to potentially cure the disease if it gets worse.
Not many studies referred to this problem. One of the few that did found that difference in death rates after more than 20 years, and another showed that surgery improved odds of surviving only for men under 65. Those studies were done prior to wide use of PSA blood tests, back when more tumors were found because they caused symptoms, which often means more advanced disease.
The new study, sponsored by the U.S. Department of Veterans Affairs, aimed to answer would the results be the same with modern screening and treatments? 731 men was assigned by doctors to observation or surgery and after 10 years survival rates were similar, longer follow-up was needed. And now after two decades, one third of this men survived, and though the numbers are in favor of surgery, original conclusions still
Fewer men in the surgery group later received treatment because signs showed the disease might be worsening – 34 percent, versus 60 percent of the group assigned to monitoring. Although in many cases it was caused by rising PSA, surgery undoubtedly prevented more cases from spreading further in the body.
Half of the group assigned to monitoring left getting some sort of treatment within five years. Three quarters of men from this group were prompted by signs of progression and the rest was exhausted by monitoring and thinking about cancer, Andriole said.
Surgery also improved survival chances for men in the middle range of risk with PSA levels between 10 and 20, and a Gleason score of 7. Although in this category belong about one quarter of men.
“Surgery is right for the right person, and it’s somebody with intermediate-risk disease,” Andriole said.
15 percent of men in the surgery group later seek treatment for trouble having sex, and 17 percent, for incontinence. While men numbers in the monitoring group were 5 percent and 4 percent. This meant that surgery had more side effects.
“You can’t divorce quality of life outcomes from cancer outcomes because they both count for patients,” said Dr. David Penson, Vanderbilt University’s urology chief.
“Some guys will look at this and say, ‘I don’t want to be impotent, I don’t want to be incontinent,’” and will forgo surgery even if there’s a chance it will help them live longer, he said. “In the end, each man’s going to make his own decision.”