Cross shows the area of an enlarged cancerous prostate

Men who undergo radical prostatectomy, or surgical removal of the prostate after being diagnosed with prostate cancer, have less risk of dying compared to those who take the watchful waiting approach, according to a continuing study of men in the Scandinavian Prostate Cancer Group.

There were 695 men from Finland, Iceland and Sweden comprising the study group. They were all diagnosed with early prostate cancer at an average age in the 60s back in 1989. This was also the period before the widespread use of prostate-specific antigen (PSA) blood test for prostate cancer screening.

The study, therefore, is not intended to evaluate the value of PSA screening on prostate cancer, which is a slow-growing tumor.

Rather, the study was designed to test whether aggressive treatment (or surgery) is the better way to deal with prostate cancer than a wait-and-see approach.

The group was divided in two. One group had prostate cancer surgery; the other group were assigned the “watchful waiting” strategy. Depending on their condition over the years, treatment was modified accordingly.

The study found that surgery resulted in 5.4 percent absolute reduction in mortality due to prostate cancer and a 35 percent reduction in risk of mortality compared with watchful waiting.

But the benefits from surgery were obtained mostly in the first 10 years and disappeared after that. For both groups the overall death rate was statistically the same, albeit there appeared to be a trend that favored surgery.

There was also a clear benefit for men younger than 65 who had prostate cancer surgery, where the cancer was detected by other methods (not PSA testing).

The researchers note at least two points, however:

* It is not clear if their results apply to present male populations, who are now diagnosed using the PSA blood test.

* The research did not make any quality of life comparisons, which can be a factor.

One of every six American men is diagnosed with prostate cancer each year. PSA screening can often detect tumors that may never become full-blown threats to life; yet, they may lead to surgery and other invasive treatment (e.g. radiation therapy) which have associated risks and side effects but may actually be unnecessary.

Because of the prevalent uncertainty, an expert panel in the U.S. recommended last week that PSA screening should exclude men over 75 years as its benefits would be minimal.

The panel also said it is not yet clear from existing evidence that younger men benefit from early detection of prostate cancer.

The Scandinavian researchers did say that the watchful waiting approach may be outdated. Instead, active surveillance, where doctors monitor patients’ condition more closely to determine the course of further treatment, is now a favored alternative to surgery.