The removal of the prostate is not always justified when cancer is detected. The approach to take is always a subject of hot debates. However, a study published in two parts in the New England Journal of Medicine may well settle this issue for good. Conducted by the University of Oxford (UK), it shows that between surgery, radiation therapy and active surveillance, no difference emerges on survival. The study was conducted for a decade and involved 82,429 men aged 50 to 69 years.
Among the volunteers, a prostate tumor was detected in 1640 cases, using a PSA Test, which measures a marker protein of the activity of the organ. Randomly selected, the participants were divided into three groups. The first group went through a complete removal of the gland, the second used radiotherapy and the third group was simply followed more regularly, in order to observe the evolution of the tumor. This is the first time a study of this type has been carried out.
The results are rather positive overall: 99% of the men are still alive after 10 years. An astonishing rate, but mostly stable in the three approaches.
The differences between the three approaches lie on the side effects of each, rather than in their inherent process. Treatment with surgery induces long-term side effects, especially strong in the year following surgery. Prostatectomy doubles the number of men who suffer from urinary incontinence and sexual problems compared to radiotherapy. The troubles persist for 6 years. Ray treatment, on the other hand, increases the frequency of bowel disorders. “Every treatment has an impact and different effects, and we need to do a longer follow-up to observe their equilibrium over the next 10 years,” says Professor Jenny Donovan, who participated in the study.
These side effects may seem necessary given the benefits they provide: the progression of the tumor when surgery is performed is halved compared to monitoring. But that does not translate into improved survival. “No progress occurs in three quarters of men under surveillance in the 10 years of follow up,” said Professor David Neal, co-author of the study. Another decade of additional observations will be needed to confirm these results. The stakes are real because the work is part of a reassessment of the approach to take for prostate cancer as the effectiveness of many approaches remains questionable.