UPDATE - Issue 13 - January 2003
Controversy from Swedish trial results
Radical prostatectomy is widely used in the treatment of early prostate cancer. It is often argued, however, that the benefits are unclear and unproven. The results of a Scandinavian study into this question were published in the New England Journal of Medicine recently producing amazingly diverse press reactions. Headlines were largely positive in the US and negative in the UK.
The trial followed the progress of 695 men over seven or eight years. All had been diagnosed with prostate cancer that had not spread outside the gland. These patients were split into two groups at random. Half had their prostates removed surgically and half did not.
Significantly more men died of prostate cancer in the watchful waiting group (31) than in the prostatectomy group (16). The risk of the cancer spreading to produce metastases in the bones and elsewhere was also tracked by the study and showed some clear benefits of surgery but only achieved convincingly after a number of years.
Deaths from all causes were not so very different in the two groups. One in every five and a half men died in the watchful waiting group compared to one in six and a half of those who had received surgery. 62 compared to 53. It was this fact which led to contributions to the British Medical Journal carrying the headlines "Watchful waiting as good as surgery" and "The operation was a success (but the patient died)"
All this seems to us to confirm that the lobby against PSA testing and, indeed, against acting to cure prostate cancer in the UK is thriving.
We asked two very experienced surgeons to comment on this landmark trial. John Fitzpatrick and Roger Kirby explained that the selection of patients much older and less fit than would be typical today accounts for the surprisingly high overall death rate. "The mean age of our own last 100 cases was 61" they said. "The mortality from all causes of recent patients should be considerably lower than that seen in the Scandinavian sample. The reduction in cancer mortality and the rate of development of metastases would be likely to have a more significant impact, especially over a longer follow-up period."