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In a new Swedish study, researchers concluded that men with early prostate cancer had a lower mortality rate after undergoing prostate removal surgery compared to those who practiced watchful waiting (closely monitored by doctors).
The 20-year-long study was published March 6 online in the New England Journal of Medicine (NEJM).
The study included 695 men from Sweden, Finland and Iceland, who were diagnosed with prostate cancer between 1989 and 1999. These men were not diagnosed using the prostate specific antigen (PSA) test, which is now commonly used in the U.S. Half of the men (347) were randomly assigned to undergo surgery to remove the prostate (radical prostatectomy), while the other half (348) were closely monitored and only had surgery if the cancer worsened.
By the end of 2012, 200 men in the surgery group (56 percent) and 247 men (69 percent) in the monitoring group had died. Of these deaths, 63 men in the surgery group and 99 men in the latter group died due to the effects of the cancer, itself.
The men who were assigned to the watchful monitoring group were more likely to have their cancer spread throughout the body. Most times, the metastases were not serious. However, metastases detection often led to treatment with hormone therapy. The side effects of therapy would significantly negatively affect the patient’s quality of life, according to the study.
Based on their results, researchers found that surgery most benefitted those under 65 years old, as well as men whose prostate cancer was at intermediate risk. Researchers also found that older men had a reduced risk of metastases due to radical prostatectomy.
The findings of this study differ from those from the Prostate Cancer Intervention Versus Observation Trial (PIVOT), which suggested that prostate surgery did not reduce mortality rates when compared to watchful waiting. The patients in this study were diagnosed with prostate cancer through PSA testing.