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Most Prostate Cancer Treatment Doesn’t Save Lives

A 10-year outcome study just published in the prestigious New England Journal of Medicine shows that men diagnosed with prostate cancer who chose to forgo treatment were no more likely to die. Surgery and radiation therapy often have severe side effects such as incontinence and impotence.

The study, 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer followed the progress of 1634 British men who were randomly assigned to treatment or active monitoring.

I have recently been seeing promotions on social media for Blue September New Zealand that suggest I should get screened:

We’ve all got fears. But a prostate check shouldn’t be one of them. Each year prostate cancer kills 600 Kiwi men – now that’s scary. So this Blue September, we want you to face your fear for prostate cancer awareness month.

There is an easier to read discussion about prostate screening and treatment at On Science Blogs: Prostate cancer disputes and media matters: Watchful waiting OK?

PROSTATE CANCER: WATCHFUL WAITING IS PROBABLY SAFE

The prostate-specific antigen test for prostate cancer was developed in the 1990s, quickly followed by an explosion of PSA screening for the disease and a further explosion of treatment. Treatment consists of either radiation or surgical removal of the prostate. The treatments have hard-to-live-with side effects such as urinary and bowel incontinence and loss of sexual function.

Yet the disease itself is often not particularly life-threatening. It’s a truism that most men diagnosed with prostate cancer will die of something else first. Experts grew alarmed at the rush to treatment, much of which was likely to injure patients without extending their lives. They began arguing against routine PSA screening, especially mass screening.

Now there is strong evidence that watchful waiting is a reasonable approach for most men with prostate cancer. British scientists studied more than 1600 men for 10 years. The men had been randomized into groups that had surgery or radiation or underwent only “active monitoring.” Most of the men survived no matter which group they belonged to.