August 29, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume VI, Winter 2003
Scandinavian Study Shows Surgery Saves Lives


New From
Warner Books – 2002

“The ultimate book on the No. 1 men’s disease in the world…should be in every man’s home.”
                —USA Today

“All men – and their loved ones – battling or concerned about prostate cancer should read this book.”
           —Publisher’s Weekly

Everything You Need to Know About Prostate Cancer Major medical breakthroughs are enabling more and more men to survive prostate cancer. Once a dreaded killer, the disease can today be managed with a wide range of powerful new strategies. Now this lifesaving guide by Patrick C. Walsh, M.D., Urologist-in-Chief, and award-winning science writer Janet Farrar Worthington offers a message of hope to all those facing this illness. Learn:

 - The risk factors of prostate cancer, including heredity, diet, and environment  

  - Why a diet rich in fruits, vegetables, grains, and less red meat may help prevent or delay prostate cancer

 - Why the digital rectal exam and PSA test might save your life

 - The latest treatment options—from Dr. Walsh’s “nerve-sparing” radical prostatectomy to new radiation techniques and promising drugs for advanced prostate cancer

 - Effective methods for recovering continence and potency after treatment.

www.twbookmark.com
Available in bookstores everywhere. $16.95

SOME of the most exciting news in prostate cancer treatment has come from Scandinavia, where so many men die of this disease. A groundbreaking study, conducted by the Scandinavian Cancer Group and published in the September 12, 2002, issue of the New England Journal of Medicine, provides the first concrete evidence that treating localized disease reduces deaths from prostate cancer.

In the study, involving hospitals from Sweden, Finland, and Iceland, nearly 700 men with localized prostate cancer were randomly assigned to radical prostatectomy or to watchful waiting, the most common form of treatment in those countries. During the average follow-up of six years— a surprisingly short time—twice as many men in the watchful waiting group died of prostate cancer. This means, the scientists concluded, that radical prostatectomy may reduce prostate cancer deaths by about half.

A man’s risk of dying from prostate cancer exists for 20 to 25 years after he is diagnosed. In another study from Sweden, 63 percent of men who were treated with watchful waiting, who lived longer than 10 years, eventually died of prostate cancer. In the Scandinavian study, at 8 years, there was an absolute reduction of 14 percent in the number of men whose cancer had progressed to distant metastases (27 percent of men in the watchful waiting group developed metastases, compared to 13 percent in the surgery group). The scientists, noting that the average survival of men with distant metastases is only about two to three years, anticipate that with longer follow-up, the differences in cancer deaths between these two groups will become even more distinct.

What about quality of life? The men who had surgery experienced more erectile dysfunction and urinary leakage, and less urinary obstruction than the men in the watchful waiting group. However, in the Scandinavian trial, nerve-sparing surgery was not routinely performed. Also, many men in the trial were over age 65, and thus more likely to experience problems with incontinence and impotence. And 20 percent of these men had received hormonal therapy within five years after being diagnosed with cancer.

Any of these three factors—the lack of a standardized, nerve-sparing procedure, older age, and the use of hormonal therapy —could explain why there were more complications with radical prostatectomy in this study than if the operation had been performed uniformly, at a center where many of these procedures are done each year.

The men in the watchful waiting group experienced erectile dysfunction and urinary leakage, as well, either from progression of the cancer—which occurred in 60 percent of these men—or from the treatment of it. As a result, at four years, there was no significant difference in quality of life in the two groups.

And finally, in this study, 75 percent of the Scandinavian men were diagnosed with cancer advanced enough to be felt during a physical exam, and only 10 percent were diagnosed with non-palpable cancer, because of an elevated PSA. This is in sharp contrast to the United States, where 75 percent of men are diagnosed on average five years earlier, and at a much more curable stage—with non-palpable cancer, detected because of a change in PSA.

“How should the results of this study influence the advice we are giving patients?” asks Urologist-in-Chief Patrick C. Walsh, M.D., in an accompanying editorial in the New England Journal. “Should no one have watchful waiting? Should all patients undergo radical prostatectomy? The answer to both of these questions is a categorical ‘no.’” There have always been, and “always will be,” men who are best served with watchful waiting, Walsh continues. Many of them are “men who are too old or too ill to survive longer than 10 years. If their cancer progresses to the point where it causes symptoms, there are many ways to palliate the disease.” Other men who are good candidates for watchful waiting are men with slow-growing, low-volume cancer, he adds. (Read story ) For men with more significant cancer that needs to be treated, there are two good options, Walsh says. “For young, healthy men, there is no better way to cure prostate cancer than surgery. And if this operation is performed by experienced surgeons, their quality of life should be excellent.”

For men who are older, or who have other health problems that may preclude surgery, radiation therapy is the best option, and offers the fewest side effects, he adds. “Over the last decade, radiation therapy has been improved, providing higher-dose delivery targeted more specifically to the prostate.” Walsh notes that although the Scandinavian trial shows that surgery reduces deaths from prostate cancer, no similar trial of radiation therapy has been carried out, although several studies comparing radical prostatectomy to external-beam radiation and brachytherapy are in the works.

 

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