Watchful Waiting or Surgery for Prostate Cancer?

from GeriPal

What should be done in men who have prostate cancer? On first examination, it might seem that the obvious answer would be “take it out of course!” But it actually is not so simple. In fact, the management of early stage prostate cancer (a cancer that has not spread beyond the prostate) has been one of the most difficult and controversial questions in medicine.

(snip)

The investigators enrolled 695 with localized prostate cancer between 1989 and 1999 to either surgery (radical prostatectomy) or watchful waiting. The men were followed for up to 15 years. There were striking differences in the impact of surgery in younger and older men.

Among those younger than 65 years old, 34% of those who had surgery died while 47% of those who did not have surgery died. This means that for every 7 younger patients who had surgery, 1 more patient survived 15 years. 

Among men over the age of 65, there was absolutely no survival benefit from surgery. 57% died after 15 years in both groups. This mean that older men suffered all the complications of surgery with no survival benefit in return.

A caveat should be kept in mind. This study was done before PSA screening was common. Most of the cancers were discovered because of symptoms, or because a prostate nodule was detected on physical exam. Cancers that are detected by PSA are less advanced, and the period of time needed for them to cause complications that become lethal is considerably longer. Thus, the age at which surgery becomes nonbeneficial for PSA detected tumors would be younger. It is hard to know for sure what this age cutoff would be, but I would guess around 60.

(Original here.)