Men should rethink surgery for early-stage prostate cancer

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Observation only may be the best medicine for men with early-stage prostate cancer, suggests a 20-year study.

The study is published in The New England Journal of Medicine.

Early-stage prostate cancer means the cancer is small, confined to the prostate gland, and can only be detected with a biopsy.

Researchers randomly assigned 731 men, average age 67, with localized prostate cancer to receive either surgery or observation only.

At the 20-year follow-up, 62% of the men who had prostate cancer surgery had died of other causes, while only 7% died from prostate cancer.

In comparison, 67% of the men assigned to observation died from other causes and 11% from prostate cancer. The absolute differences in mortality were not significant.

Most striking was how often erectile dysfunction and urinary incontinence occurred following surgery.

For instance, 80% of the surgery group reported having erectile dysfunction throughout the study, compared with 40% of the men who were not treated.

And more than 40% of the men who’d had surgery needed to use a daily pad to manage the urinary incontinence, compared with less than 10% of the observation group.

The researchers concluded that for most men ages 65 and older with localized, early-stage prostate cancer, observation might be the preferred treatment.