When men make prostate cancer treatment decisions, they need to weigh the pros and cons of their options. For those considering surgery, new research compares this approach with two others: watchful waiting and active monitoring.
Surgical removal of the prostate gland is called radical prostatectomy. It is a common treatment for men with localized prostate cancer. (Localized means that cancer cells have not spread outside the prostate gland itself.)
However, prostatectomy has its drawbacks. Because the prostate is surrounded by nerves that affect erections, many men have erectile dysfunction (ED) afterward, and it can take time for erections to recover. Urinary incontinence is another frequent complication of prostatectomy.
There might be other options to consider, however. One is watchful waiting. With this approach, men don’t have treatment right away. When they do, the treatment goal is to manage the complications of cancer, not cure the cancer.
Another option is active monitoring (sometimes called active surveillance.) In this case, men don’t have treatment at first, but their symptoms are monitored regularly. When the cancer becomes more concerning, then treatment begins with the goal of curing it.
Is there an advantage to delaying treatment? Prostate cancer tends to grow slowly, so waiting to have treatment can postpone side effects.
The new study, published by the Cochrane Library, investigated all of these approaches. Researchers analyzed four studies including 2,635 men overall.
Three of the studies compared radical prostatectomy with watchful waiting. After analyzing 29 years of follow-up data, researchers determined that men who undergo surgery “probably” have a lower risk of dying from any cause or from prostate cancer itself. They may also be at reduced risk for prostate cancer becoming more aggressive and spreading outside the prostate.
Patients who had surgery tended to have more issues with erections and incontinence. But after twelve years, patients who had either treatment reported high quality of life levels.
The one study comparing prostatectomy with active monitoring found few differences in the risk of dying from any cause or from prostate cancer in 10 years of follow up. The changes of cancer worsening and spreading were probably less for men having surgery, and quality of life was similar for all the men. However, as with watchful waiting, incontinence and ED were more common in men who had had a prostatectomy.
“Based on long-term follow-up, [radical prostatectomy] compared with [watchful waiting] probably results in substantially improved oncological outcomes in men with localised prostate cancer but also markedly increases rates of urinary incontinence and erectile dysfunction,” the authors wrote.
“Compared to [active monitoring], based on follow-up to 10 years, [radical prostatectomy] probably has similar outcomes with regard to overall and disease-specific survival yet probably reduces the risks of disease progression and metastatic disease,” they added, noting again that erections and urinary function were likely to be impaired for men having surgery.
Vernooij, Robin W.M., et al.
“Radical prostatectomy versus deferred treatment for localised prostate cancer”
(Abstract and plain language summary. Published: June 4, 2020)
Reuters Health Information via Medscape
“Radical Prostatectomy Curbs Cancer Risks but Ups Adverse Events Compared With Waiting, Monitoring”
(July 1, 2020)