Cancer

Surgery isn’t necessarily best for prostate cancer, according to study led by Minneapolis VA

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The largest and longest trial to compare treatment options for men with prostate cancer has found little difference in outcomes between men who underwent surgery vs. those who were simply observed by their doctors.

Led by a researcher at the Minneapolis VA Medical Center, the 20-year national study provides the best evidence yet that most men can live with their prostate cancers, avoiding the potential risks of surgery. The results, though, did show that surgery was probably a better option for younger men with long life expectancies, and some urologists dispute the findings.

“Our results demonstrate that for the large majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer, and prevent harms from surgical treatment,” said Dr. Timothy Wilt, an internist at the Minneapolis VA who led the study, in an e-mail.

A decade ago, doctors often recommended surgery or radiation to remove prostate cancers, Wilt said, but the results suggest a more conservative course in most cases.

Dr. Christopher Knoedler of Metro Urology in the Twin Cities said about one-third of patients in his practice with prostate cancer undergo observation rather than surgery. He remains a strong advocate for regular prostate screenings and still offers prostate removal surgery to most patients, but said he will use the study’s findings in discussions with patients who might not need surgery.

“Some patients get that C word and they want to be treated,” Knoedler said, “but they don’t always need to be treated.”

More than 700 men with prostate cancer were randomly assigned between 1994 and 2002 to two treatment groups, and researchers then monitored their progress.

Because prostate cancer is commonly found in older men, most research participants died during the prolonged course of the study. But prostate cancer was the cause of death in only 27 men who underwent…