Prostate cancer study shows early surgery saves lives

(CBS/AP) Men diagnosed with prostate cancer often face a tough decision: head to the operating table right away, or wait to see if the cancer gets worse.

A new study out of Sweden might help patients with this difficult choice.

The study showed that men under 65 with early prostate cancer were less likely to die if they had surgery right away than men who delayed surgery, according to scientists at University Hospital in Uppsala and Karolinska Institute in Stockholm.

Doctors have long debated whether and how to treat such early cases, and the study shows "there clearly is a benefit to getting the cancer out in the younger population," said Dr. Richard Greenberg, urology chief at Fox Chase Cancer Center in Philadelphia.

But the benefit may depend on how a man is diagnosed.

Almost 95 percent of the cancers in the study were detected because they were causing symptoms. American docs, on the other hand, tend to diagnose prostate cancer long before symptoms appear, if a PSA blood test suggests a problem. Most of these cancers will not prove life-threatening, but there's no sure-fire way to tell which ones will, so many men get treatment they may not need.

The study kicked off in 1989 when Swedish researchers assigned nearly 700 men under 75 either to have surgery right away or to be monitored and treated if their cancer got worse. After 13 years of follow-up, there were fewer deaths among those who had surgery - 166 versus 201 deaths. That means surgery lowered the risk of dying of prostate cancer within 15 years by 38 percent. But the benefit was significant only for men under 65.

Prostate cancer surgery can be risky and lead to side effects, including erectile dysfunction and urinary trouble. Surgical techniques, however, have improved since this study began, and now use approaches that minimize the nerve damage that causes these problems.

The study "has provided important evidence that effective treatment is both necessary and possible for many men with early-stage prostate cancer," Dr. Matthew R. Smith of Massachusetts General Hospital wrote in an editorial that accompanied the study.

But whether surgery benefits men with early cancers detected through PSA tests rather than symptoms remains to be seen, he added.

The study was published in the May 5 New England Journal of Medicine.