Radical Prostatectomy No Benefit Compared With Simple Observation

Radical Prostatectomy

According to a study published in The New England Journal of Medicine, there are no significant differences in terms of mortality in patients treated by radical prostatectomy compared with just observation. The study, led by Timothy J. Wilt, M.D., M.P.H., from the University of Minnesota School of Medicine in Minneapolis, was conducted on 731 men with localized prostate cancer patients and follow-up lasted about 10 years. Selection of the patients took into account primarily the tumor stage (T1, T2N0M0, that is without ganglionic invasion or distant metastases), age (which was more than 75 years), and the PSA value (which was than 50 ng per milliter).

Prostate Cancer

The 731 patients were divided randomly into two groups: first group (364 men) underwent radical prostatectomy, while the second (367) was assigned to observation. What investigators found was that the mortality rate was 47% in the first group and about 49% in the second group. So there were no significant differences in terms of mortality rate in both groups. Also, 21% of men had adverse effects operate in the first 30 days after surgery, including a case of death. Bone metastases occurred in 4.7% of patients assigned to radical prostatectomy and 10.6% of men undergoing observation.

Prostate cancer is the sixth leading cause of death induced by cancer in men. Prostate cancer can be asymptomatic or have symptoms similar to benign prostatic hyperplasia, for example difficulty in urinating(dysuria), nocturia (urination at night), possibly hematuria. In advanced stages metastases occur most often in bones (vertebrae, femur, hip bones, ribs, etc.) and lymph node. Bone metastases are usually manifested by pain or compressive phenomena, which, if vertebrae are interested, can lead to fecal or urinary incontinence or other neurological manifestations. It should be reminded also the general symptoms that usually occur in any type of cancer: weight loss, anorexia, asthenia.

There are many factors involved in prostate cancer: heredity, testosterone, sexually transmitted infections. Also, it seems that obesity, high fat diet, smoking are risk factors for prostate cancer.Prostate cancer treatment consists of surgery (prostatectomy), radiotherapy, chemotherapy, cryotherapy and hormonal therapy. Recently, the FDA approved a vaccine (sipuleucel-T) for the treatment of prostate cancer resistant to hormone therapy. It seems that the vaccine increases survival in these patients.It is recommended that all men over 40 screening perform tests for prostate cancer: rectal examination and PSA measurement. The latter is a blood test that measures the amount of prostate specific antigen, a protein released by prostate blood. However,  PSA is not elevated only in prostate cancer but also in prostate infection or inflammation.