Highlights
- Researchers have found that waiting may be a viable alternative to prostate cancer surgery.
- Radical treatments like surgery can reduce the chances of prostate cancer spreading to other organs.
- The new data suggests that only those predisposed to developing lethal prostate cancer should undergo screening.
- Erectile dysfunction drugs can help patients reclaim their sexual lives after prostate surgery.
Researchers of the University of Oxford and Bristol Medical School recently published the results of a decade-long study on prostate cancer survival. They concluded that prostate cancer surgery and radiotherapy aren’t better than active surveillance in improving the survival rates of low-risk prostate cancer patients.
Waiting and watching may be a viable alternative to prostate cancer surgery for many.
| Treatment | Effects |
| Active surveillance | Gradual loss of erectile function over time. Erectile dysfunction worsens with age. |
| Prostate cancer surgery | Immediate loss of erectile function and no recovery over time. FDA-approved medications like Viagra can help. |
| Radiation therapy | Immediate loss of erectile function, some recovery, then gradual loss. Viagra can help. |
Are Some Prostate Cancer Surgeries Unnecessary?
According to the conclusions of the study, they may be, and current screening guidelines could use improvement. According to the authors of the study, here’s how we currently deal with prostate cancer.
Problems with Prostate Cancer Treatment, Detection, and Screening
Past a certain age, doctors recommend that all men should have prostate-specific antigen (PSA) tests to screen for prostate cancer. First, we test — then, we think.
If the PSA test returns elevated levels, doctors proceed to take biopsies for further testing. Once again, we test before we think.
Should the biopsy return a positive result for prostate cancer, doctors may push patients to have radical radiation therapy or prostate cancer surgery. Then they ponder the consequences.
According to the study authors, doctors should change this approach. They believe that their research has collected enough data to hand medical professionals the means to alter their screening and treatment practices.
The solution these researchers propose is targeted screening. Using the biological samples of patients who passed away during the study, they created genetic and molecular profiles of those patients who died from the disease. Testing only those who match those profiles would allow the medical industry to treat prostate cancer more efficiently.
Details of the Study
During the decade from 1999 to 2009, researchers followed 1,640 prostate cancer patients from an initial pool of over 82,000 they had tested for PSA. Those who took part in the study had cancer localized to their prostates only.
Of these patients, doctors randomly created three groups. One had prostate cancer surgery to address the disease. Members of the second group were treated with radiotherapy.
The third group relied on active surveillance. Active surveillance meant regular PSA tests to look for spikes that would indicate progression of the disease.
Researchers looked at how many people died in each group from prostate cancer in 10 and 15 years. The results surprised them.
Surprising Results
They found that invasive prostate cancer treatments reduced the odds of cancer spreading to other organs. But these favorable findings did not show that prostate cancer surgery and radiotherapy recipients would survive longer or in higher numbers than those in the active surveillance group.
As the years went by, some patients under active surveillance had surgery or radiation therapy due to anxiety; others didn’t. The results continued to point to no difference in survival rates between the two groups.
What Does This Mean from a Clinical Perspective?
Over the years the study covered, patient survival rates were high. Researchers found that metastasis (the spreading of the disease) did not affect these rates. They concluded that patients who died from prostate cancer must have had a genetic predisposition to developing deadly forms of the disease.
They didn’t identify the genetic and molecular factors involved in this predisposition. But they noted that they accumulated enough genetic material for further research.
Study Limitations
Critics pointed out that the study participants all had low-risk prostate cancer. Researchers argue that over the course of the study, doctors discovered many had more advanced disease than previously thought.
Other critics thought the study advised high-risk prostate cancer patients not to receive timely treatment. The authors disagree. They agree that people with high-risk disease should get aggressive treatment as early as possible.
New imaging and biomarker technologies do not invalidate the active surveillance model of the study.
Quality of Life Implications
Interestingly, the study also concluded that actively monitoring the disease rather than undergoing radical intervention didn’t make a significant difference in the quality of life of patients.
The study found no significant differences in the study participants’ urine leakage and bowel function problems. However, erectile dysfunction was a problem in all three groups. By the 12-year mark, all participants noticed a significant loss of erectile function. Given the length of the study, age also impacted the erectile dysfunction scores of patients.
Conclusions
Researchers found the lack of difference in mortality between prostate cancer surgery and active surveillance puzzling. Now, they plan to extend the study.
Radical treatments like radiation therapy may lower mortality over a longer period than the 15 years they have considered thus far. If they fail to show a difference in 20 years, radical therapies may not impact prostate cancer mortality at all.
Using the biological samples obtained from participants who died of prostate cancer, doctors could establish biomarkers to use to narrow the scope of prostate cancer screening.
Long-term Implications
Patients should understand the long-term implications of radical treatments like prostate cancer surgery and radiation therapy and those of active surveillance. Radical treatments usually lead to a sudden loss of erectile function, affecting sexual activity and intimacy. At the same time, however, they reduce the risk of cancer spreading to other organs.
While active surveillance may not negatively affect prostate cancer survival in most cases, it can have a gradually damaging effect on erectile function and quality of life. FDA-approved erectile dysfunction medications can work well for prostate cancer patients, whether or not they have surgery.
For their part, doctors should provide patients with all the information they need to make educated decisions about how they manage their prostate cancer. If your provider doesn’t lay out all risks and benefits of your treatment options, ask.
“We do know now that they have time to make that decision.” – Jenny L. Donovan, Ph.D., FMedSci.
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James West is a seasoned health and wellness writer with a focus on topics related to physiology, sleep, and men’s health. He has contributed articles on a range of subjects, from erectile dysfunction treatments and sleep aids to hair loss, providing well-researched insights to help readers make informed health decisions.