Surgical removal of the prostate is associated
with a reduction in the rate of death from prostate cancer, according to a new
Prostate cancer is a cancer that develops in the prostate gland, commonly affecting males above the age of fifty years. The prostate is a small, walnut-sized
structure. It forms part of the male reproductive system. There are four
modalities of management of a cancer of the prostate: Watchful waiting,
surgery, radiation therapy, and hormone therapy.
Radical-prostatectomy refers to surgical removal
of the prostate. A recent study compared radical-prostatectomy with watchful
waiting, i.e. close observation of changing
symptoms and disease progression rather than initiating treatments all of a
sudden. The study group was divided into two, one receiving surgery and the
other being observed (watchful waiting). A total of 347 men were
assigned to the radical-prostatectomy group, and 348 to the watchful-waiting
group. 'There continues to be a significant
reduction in the rate of death from any cause, the rate of death from prostate
cancer, and the risk of metastases in the radical-prostatectomy group as
compared with the watchful-waiting group', quote the authors. The results were
published in the New England Journal of Medicine, a leading medical journal.
The benefit was obvious among men younger than 65
years of age. Whether the benefit extends to older men is still unclear. The
benefit of radical prostatectomy continued to be seen beyond 9 years. In some
men, the tumor grows further, thus developing 'extracapsular tumor growth'.
Such men were found to benefit from adjuvant, local or systemic treatment.
The current study that favors surgical resection
of prostate is not conclusive though relevant. The observations are sharp, but
further scrutiny is required.
Anna Bill-Axelson, M.D., Ph.D., Lars Holmberg, M.D., Ph.D.,
Mirja Ruutu, M.D., Ph.D., Hans Garmo, Ph.D., Jennifer R. Stark, Sc.D., Christer
Busch, M.D., Ph.D., Stig Nordling, 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., Juni Palmgren, Ph.D., Gunnar Steineck, M.D., Ph.D.,
Hans-Olov Adami, M.D., Ph.D., and Jan-Erik Johansson, M.D., Ph.D. for the SPCG-4 Investigators;N
Engl J Med 2011; 364:1708-1717.