Not always worth the wait: Prostatectomy for younger prostate cancer patients?

Related articles

Previously, ACSH has emphasized that older men diagnosed with prostate cancer should not be rushed off to a radical prostatectomy (removal of the prostate and seminal vesicles). But today we learned that for younger men — those under the age of 65 — diagnosed with early prostate cancer, a prostatectomy may be better than watchful waiting (WW) when it comes to both prostate cancer-specific and all-cause (total) mortality.

Reporting in the New England Journal of Medicine, researchers from Sweden’s Uppsala University Hospital’s Department of Urology monitored a cohort of about 700 men diagnosed with early prostate cancer. They were randomly assigned to undergo either radical prostatectomy or WW; the results were previously reported for a 9-year follow-up in 2008. The new study gives data covering an additional three years, resulting in a total follow-up period of 15 years. Patients were considered to have early prostate cancer if their tumors were localized to the prostate, they had a prostate-specific antigen (PSA) score below 10 nanograms per milliliter, and a Gleason score — based on an evaluation of prostate biopsies for any cellular changes indicating aggressive cancer — of less than seven. The patients receiving surgery experienced a significantly reduced risk of both prostate cancer-specific and all-cause mortality — a 38 percent and 25 percent reduced risk, respectively, compared with the WW group.

These results, however, only applied to men under the age of 65, which does not surprise ACSH's Dr. Gilbert Ross. “When we discuss WW, we think of older patients who are much more likely to die with prostate cancer — not from prostate cancer. Compare this with, say, a 55-year-old prostate cancer patient, who is expected to live another 30 years and would thus be subject to a longer period of possible cancer spread, as well as lower rates of other diseases.” He adds, “Younger men with prostate cancer can benefit from radical prostatectomy, but the patient and doctor should have a lengthy risk-benefit discussion before electing for surgery, given that the complications of radical prostate surgery — impotence and incontinence — are so dire.”