Surgery unnecessary for many prostate cancer patients

Otherwise healthy men with advanced prostate cancer may benefit greatly from surgery, but many with this diagnosis have no need for it. These conclusions were reached by researchers after following a large group of Scandinavian men with prostate cancer for 29 years. The results are now published in The New England Journal of Medicine.

The research findings now presented are from the 29-year follow-up of the Scandinavian Prostate Cancer Group Study Number Four (SPCG-4), investigating the benefits of surgery for prostate cancer. The study comprised 695 men who were randomly assigned to two groups, one to get surgical treatment and the other to receive treatment of symptoms only (“watchful waiting”).

The men in this study were diagnosed between 1989 and 1999. Only a few (12 per cent) of them had their cancer detected early by having their blood tested for prostate-specific antigen (PSA). The study was carried out during the period before large-scale use of the PSA test began in Scandinavia.

After 29 years’ follow-up, 80 per cent of the men had died. For 32 per cent of these, death was due to prostate cancer. Seventy-one men in the surgery group died of prostate cancer, while 110 did so in the group receiving symptom treatment only. The study showed that 12 per cent of those who had prostatectomies had been saved from dying of prostate cancer; that 19 per cent had incurable cancer; but that the majority of the men had died of other causes. The results also showed that the men who had been operated on lived, on average, 2.9 years longer than the men who received treatment of symptoms only.

It is evident from the study that men who are otherwise healthy and whose advanced prostate cancer is confined to the prostate gland alone may benefit greatly from the surgery. Nevertheless, it was also found that, despite their diagnoses of prostate cancer, many men never suffered from a serious relapse during their lives, nor died from the disease. For the treatment to be optimally beneficial for men with prostate cancer, it is therefore crucially important to find the correct balance between the benefit from prostatectomy, on the one hand, and its side-effects on the other.

Through PSA, many men are now being diagnosed with prostate cancer who will never develop advanced or life-threatening symptoms. Compared with the 1990s, more men with prostate cancer should thus be actively followed up and treated only if signs of advanced cancer are present.

For more information, contact Anna Bill-Axelsson, email: anna.bill.axelson@surgsci.uu.se Mobile phone: +46 70-167 9747.

Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up, N Engl J Med 2018;379:2319-29. DOI: 10.1056/NEJMoa1807801.