The latest on prostate cancer

If you’re a guy and a biopsy shows you have early prostate cancer, it’s tough to know what to do. That’s because the cancer could be either the kind that grows so slowly it never amounts to anything and you’ll die with it; or the cancer could progress and you could die of it. Early on, there’s no way to distinguish between the two types. If you opt for surgery—which perhaps was unnecessary—it is likely to leave you impotent and incontinent. With radiation, you’ll have bowel problems and also impotence (usually not permanent).

A new study tried to help with that decision. Researchers divided 1,643 men with a diagnosis of early prostate cancer into three groups: a third had surgery, a third had radiation, and a third had active monitoring. Active monitoring involves regular exams of the prostate, periodic biopsies, and PSA tests that may indicate the disease is worsening.

Of the monitored group, 33 of them had the cancer spread to distant parts of their bodies. But it also spread in 13 who had surgery and 16 who had radiation. As time went on, more and more of the monitored patients wound up having treatment, but not all those actually needed it. In fact, 80 percent of them had shown no signs of progression. Apparently they (or their doctors) lost their nerve.

Overall, researchers found no difference in death rates between men who had surgery or radiation and those who were actively monitored and who were treated only if the cancer progressed. Also, death rates were low: only about one percent of patients died ten years after the diagnosis.

As far as I’m concerned, the takeaway from this study is that you’re better off with the active monitoring. If it looks like the disease is progressing, you can have surgery or radiation. On the other hand, you could be among the group with the slow growing cancer who will never need treatment—and thus not have to deal with the side effects.

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