Surgery best option for younger guys?

Younger Guys -> Under 65

"The study found that those younger than 65 who underwent surgery to remove their prostates had a 15.8 percent lower risk of dying from prostate cancer than patients who had not had surgery. They also had a 25.5 percent lower risk of dying from any cause, as well as a 15.8 percent lower risk of the disease having spreading to other organs."

I almost stopped reading when I saw the 25.5 ...from ANY CAUSE.

Any cause is a very wide brush stroke.... Auto Accidents would fall into the any cause category.

"A 25.5 percent lower risk of dying from any other cause" does seem puzzling.   Like Steve mentioned, it doesn't make any sense that having your prostate removed reduces your chances of dying in an auto accident.  I really doubt that having your prostate removed would be much if any influence on other diseases that can be fatal like heart problems or other types of cancer.

Davidg called it...there are studies that validate all choices. No sooner was the ink dry on this NEJM article before it was questioned "...because the study was done before PSA testing became common, and a newer study found the opposite." Here is the opposing article: www.montrealgazette.com/health/Swedish+study+finds+benefits+from+prostate+cancer+surgery+picture+less/9583106/story.html

Perhaps of higher interest is the embedded video starring Dr. Pete Carroll re new genetic testing to determine the aggressiveness of prostate cancer.

Jim

P. S. Credits to AYooper who sent me links to both articles earlier today.

The study found that those younger than 65 who underwent surgery to remove their prostates had a 15.8 percent lower risk of dying from prostate cancer than patients who had not had surgery.

this is confusing too, probably intentionally.

ed

Yes, Peter. The NEJM abstract itself spells out that the primary benefit of surgery was amongst "those with intermediate-risk prostate cancer." The reason for this limitation is that PSA testing was not in use and the men in the study were primarily diagnosed with PC the old-fashioned way through a lump felt on a DRE.  In other words, they all had clinical evidence of disease. This is very different than the majroity of men diagnosed during today's PSA-era with low-risk cases. In fact, Dr Philip Kantoff from Dana-Farber Cancer Institute commented on the study by speculating that "the benefits of performing immediate surgery in men with low-risk cancers would probably go away if they had been screened with PSA."

Two other interesting points from the report:

(1) little mention of the man who died from the surgical procedure; it was more common back then than today

(2) the majority of the men remaining on the "watchful waiting" arm (note: not AS) did not need any palliative treatment even after so many years (the study period was 1989-1999), indicating that even many intermediate-risk patients do not need treatment

 

Post Edited (JackH) : 3/6/2014 4:00:02 PM (GMT-7)

JackH,

Are you agreeing with me or disagreeing? The reason why Dr. Kantoff had to "speculate" that the benefit
"would" go away "if they had been screened" [ subjunctive mood, supposition contrary to fact ] was because none of the men were there because of PSA screening and, as a result, there were no (or very few) low risk men in the study. I agree with you on that. But the study doesn't say the benefit would go away for low risk men -- how could it if they weren't included?

There is evidence that surgery may not be that beneficial for at least some low-risk men (from other studies), but it is a stretch to claim to have found it in the study they are discussing.

The best treatment choice, regardless of age, is the one best suited for the actual condition and circumstances of each individual, based on their needs.

It's easy to find "proof" or "support" of virtually every position on treatments or non-treatments for PC.

And based on past threads on the subject here at HW PC, it would be a rare day, that anyone here didn't think that they got the best possible treatment.

David

And Dr Kerr has done a study to prove it. < / joking>

First, I didn't take time to read the article, but I will. What I want to share is notes from my husband's urologist back in 1985 when he was first diagnosed. It was decision time for him, surgery only one version, or radiation. The doctor's notes say that he declined surgery even after being shown the current statistics of long term survival with surgery vs. radiation for men with similar G7 aggressive tumors in younger men. He was 48. Point is almost 20 years later, surgery still seems to be getting the better response and the choices for how the surgery is done are significantly more advanced. He chose radiation, then seeds when it recurred less than 2 years later.

Would his outcome have been different? The only better outcome than almost 20 years survival would have been cure.
Pat

This study has nothing to do with Active Surveillance (AS) and is not a new study.   It’s an update to a 23-year-long study that compares prostatectomy versus watchful waiting (WW) for 695 Swedish men diagnosed with PCa between 1989 and 1999.   There was no PSA , no gleason score and no AS back then in Sweden .   IIRC, the average age in the study was 72.   AS is not the same as WW; AS means active, close monitoring of disease progression and pursuing treatment when it becomes necessary.     The WW in Sweden  is not the same as WW in North America today.   As Dr. P. Walsh said about this study in his book “… In Sweden , watchful waiting means ignoring early prostate cancer and sending the man home, telling him to come back when he has some symptoms – when the cancer has spread – and eventually treating him hormonal therapy.”   I doubt any doctors would do that today even with WW protocols.

I know that quite a few people here are saying that studies can prove anything but they are a fundamental part of scientific progress. Otherwise we are all speculating in the dark.

CONCLUSIONS
Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment.

So the conclusions of the NEJM study indicate prostatectomy is indicated in the young and the cases with high tumor risk. This is not surprising or unexpected. This particular study was only comparing the choice of prostatectomy with watchful waiting as treatment choices.

FYI the study did mention that one person died due to the prostatectomy itself.

Regards,
An

Hi geetar,

Your biopsy indicates your cancer is small and low grade. It is the smallest amount of low grade cancer they can find. That is a good reason to do AS. The fact that you are young, 55, counteracts that a little but as you say the surveillance is going to be active. And you are happy and comfortable doing AS and that it also great.

There are no black and white answers hers, only judgement calls. But your case would have never been included in this study as in 1989 to 1999 they would not have found your cancer in Europe where they didn't use PSA tests. So it has limited relevance to you.

An