06 Mar Early Prostate Cancer: Watchful Waiting or Radical Prostatectomy?
MedicalResearch.com: What are the main findings of this study?
Dr. Bill-Axelson: The main finding is that surgery reduces prostate cancer mortality but not all men need curative treatment. After up to 23 years of follow up we found that men with low-risk tumors did not have a significant mortality reduction in the disease.
Therefore, it seems very reasonable that men with low-risk tumors are better handled with active surveillance (postpone curative treatment until signs of more aggressive tumor) until some of them might show signs of progression and undergo curative treatment.
Older men with very long life expectancy might reduce their risk of metastases but have to weigh that against the side-effects of surgery with impotence and incontinence (that is even more common among older men).
I think the most interesting research question that has to be addressed in a randomized trial is when men in active surveillance should undergo curative treatment.
Anna Bill-Axelson, M.D., Lars Holmberg, M.D., Ph.D., Mirja Ruutu, M.D., Ph.D., Michael Häggman, M.D., Ph.D., Swen-Olof Andersson, M.D., Ph.D., Stefan Bratell, M.D., Ph.D., Anders Spångberg, M.D., Ph.D., Christer Busch, M.D., Ph.D., Stig Nordling, M.D., Ph.D., Hans Garmo, Ph.D., Juni Palmgren, Ph.D., Hans-Olov Adami, M.D., Ph.D., Bo Johan Norlén, M.D., Ph.D., and Jan-Erik Johansson, M.D., Ph.D. for the Scandinavian Prostate Cancer Group Study No. 4