Long-Term Study on Prostate Cancer Surgery vs. Symptom Management

Overview of Prostate Cancer

Prostate cancer ranks among the most prevalent cancers affecting men globally, particularly older individuals. The prostate, a walnut-sized gland located around the upper part of the urethra, is integral to the male reproductive system, as it produces seminal fluid that transports sperm.

Symptoms and Disease Progression

In many cases, symptoms of prostate cancer do not manifest until the disease reaches an advanced stage. Typically, prostate cancer grows slowly, with most men succumbing to other health issues rather than the cancer itself. Surgery for prostate cancer has been shown to decrease mortality rates in men with localized forms of the disease. However, there remains a lack of extensive long-term data to determine which patients may derive the most benefit from surgical intervention over a conservative approach known as “watchful waiting,” which involves monitoring the condition while managing any arising symptoms.

Research Findings

A group of researchers in Scandinavia recently published findings from a comprehensive 29-year follow-up study in the New England Journal of Medicine. This study, referred to as the Scandinavian Prostate Cancer Group Study Number Four (SCPG-4), was conducted between 1989 and 1999. It involved the random assignment of 695 men with localized prostate cancer to either undergo radical prostate surgery or receive symptom management alone.

The participants were monitored every six months for the initial two years and then annually until 2017. The study aimed to evaluate the incidence and relative risk of death from any cause, as well as specifically from prostate cancer. The researchers also assessed cancer metastasis and estimated the additional years of life gained through surgical treatment.

Study Outcomes

After 29 years, data revealed that 80% of the men involved in the study had passed away, with 32% of those deaths attributed to prostate cancer. The findings indicated that 12% of men who underwent surgery were spared from dying of prostate cancer, while 19% had developed incurable cancer. Notably, the majority of men in the surgical cohort died from causes unrelated to prostate cancer. On average, men who received surgery lived 2.9 years longer than those who opted for symptom management.

Conclusions and Recommendations

The researchers concluded that while otherwise healthy men with localized advanced prostate cancer might benefit from surgery, many individuals do not experience serious relapses or die from the disease. This highlights the importance of weighing the advantages of prostate cancer surgery against the potential side effects. Given advancements in screening that have led to increased diagnoses of early-stage, non-lethal prostate cancer, the researchers advocate for a more vigilant follow-up approach. Surgery should be considered primarily for patients exhibiting signs of advanced cancer.

References

Bill-Axelson A, Holmberg L, Garmo H et al. Radical prostatectomy or watchful waiting in prostate cancer – 29-year follow up. N Engl J Med 2018;379:2319-29. DOI:10.1056/NEJMoa1807801
Press release. Surgery unnecessary for many prostate cancer patients. Uppsala University https://www.eurekalert.org/pub_releases/2018-12/uu-suf121218.php