Immediate treatment best for under 65-year old prostate-cancer patients showing symptoms

In collaboration with Adfero

Under 65-year old men with early prostate cancer live longer on average if they have surgery as soon as possible rather than delaying treatment, according to a new analysis of data from a Swedish study.

But the finding only applies to men who were diagnosed as a result of their cancer's symptoms, rather than through PSA blood testing.

PSA is a protein that is produced by prostate cells. High levels can be a sign of cancer, although other medical conditions may also cause it to rise.

At the time the study was carried out, between 1989 and 1999, nearly all - 95 per cent - cases of prostate cancers in Sweden were discovered because they have already developed sufficiently to be causing symptoms.

But since then, PSA blood tests have become more routinely used to identify problems, and tumours are often discovered much earlier, before symptoms appear.

Because of this, doctors will often be unsure whether or not these cancers will cause harm, so it is unclear whether early surgery would offer the same benefits in PSA-diagnosed men.

The new analysis, published in the New England Journal of Medicine, shows that men who had surgery - a radical prostatectomy - at the first sign of symptoms were less likely to have died as a result of the cancer after 15 years than those who did not.

Records of 695 patients under the age of 75 with early prostate cancer identified between 1989 and 1999 were analysed. Some 345 underwent immediate surgery, while 348 were in the group where doctors decided to 'watch and wait' to see how their tumours developed.

The long-running trial was funded by the Swedish Cancer Society and the US National Institutes of Health.

After 15 years, 14.6 per cent of the surgery group and 20.7 per cent of the watchful-waiting group had died as a result of prostate cancer.

However, the results indicated that the benefits were confined to men under the age of 65.

Professor Malcolm Mason, Cancer Research UK's prostate cancer expert, commented: "This valuable follow-up of a well-known study confirms that men under 65 years with 'low risk' prostate cancer who have symptoms benefit from treatment.

"This group of men can be offered surgery or radiotherapy in the UK already, and this research may help them make treatment decisions with their doctor.

"But most men in this study were diagnosed through their symptoms, so this research doesn't necessarily tell us about UK men whose 'low risk' prostate cancer is identified through PSA screening, and who also would be suitable for active monitoring by their doctors.

"The PSA test can pick up cancers years before any symptoms appear, but doesn't predict which cancers will progress into life-threatening forms and which will be relatively harmless.

"Studies like ProTECT in the UK - which Cancer Research UK is helping fund - will help clarify treatment approaches for these groups."

Notes to Editor

  • Bill-Axelson, A, et al (2005). Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer New England Journal of Medicine, 352 (19), 1977-1984 DOI: 10.1056/NEJMoa043739