Cancer

Surgery for early-stage prostate cancer is invasive and doesn’t save lives

From the 1980s, when prostate screening became available, many men over 40 were diagnosed with early-stage prostate cancer even though they may not have had any symptoms.

The word cancer understandably strikes fear into the hearts of many, and most would assume the best course of action would be to have the cancer removed, whatever the side-effects may be.

But impotence and incontinence are no small side-effects, especially when you consider, as two new studies have done, removing the cancer is not necessarily the best option, and the cancer may not in fact require treatment at all.

Most prostate cancers take decades to exit the prostate, and most men will usually die with, but not from, prostate cancer.

Autopsy studies reveal prostate cancer in up to 40 per cent of men in their forties and 65 per cent in their sixties, but a much smaller figure of 3-4 per cent of Australian men actually die of prostate cancer at a median age of 82.

Two recent clinical trials undermine the categorisation of prostate cancer as a death sentence. They are unambiguous in their findings and seismic in their implications.

Both found men with early-stage abnormalities of the prostate who do not undergo surgery or radiation treatment, but whose condition is monitored for any progression of the cancer, live just as long as men who opted for complete removal of the prostate and now live with its immediate consequences, including incontinence, intimacy issues, bowel problems and intervention regret.

In a UK trial, three groups of men were assigned to either surgical removal of the prostate (553 men), radiation treatment (545 men) or active monitoring (545 men).

After 10 years, the total number of deaths due to any cause was 55, 55 and 59, respectively in each group.

Thus 90 per cent of men were still alive after 10 years, including those who did not receive any radical intervention.

Although surgery delayed the development of metastases (or secondary cancers) in a small number of men, the number of deaths definitively attributable to prostate cancer in each of the groups was low, only three, four and seven deaths respectively.

So the odds of dying specifically from prostate cancer in the…