Men under 65 years with prostate cancer at the beginning had better chances of survival if they had surgery immediately instead of waiting for the treatment as if their worst cancer, has obtained a Sweden study concluded.
If this was true even for tumor considered low risk because they had a very aggressive look under a microscope.
Doctors have long debated whether and how to treat them these early decisions and the study shows "clearly is an advantage to get cancer in the younger population," said Dr. Richard Greenberg, Chief of Urology at the Fox Chase Cancer Center in Philadelphia.
But there is a big caveat: the advantage may depend on how a man is diagnosed.
Approximately 95% of cancers in the Swedish study found because they were the original symptoms. In the United States, however, most are found after a PSA blood test suggests a problem, before long appear it symptoms. Most of these cancers will prove not deadly, but there is no foolproof way to say to those who will, as many men if they may not need treatment.
The study is one of the longest attempts to address this issue. It was led by researchers at Uppsala University Hospital and the Karolinska Institute in Stockholm and paid by the National Institutes of Health of United States and the Swedish Cancer Society. Results appear in New England Journal of Medicine Thursday.
From 1989, nearly 700 men under the age of 75 years were assigned to undergo surgery immediately or to be monitored and treated their cancer worsened. Most had symptoms - urinary problems, blood in the urine or semen, difficulty in obtaining an erection, or pain in the lower back, hips or upper thighs.
After 13 years of follow-up, there were fewer deaths among those who have undergone surgery — 166 versus 201 of those observed. Prostate cancer was the cause of 55 and 81 of death, respectively.
That means surgery reduced the risk of dying from prostate cancer, in 15 years 38 per cent calculated researchers. But the advantage was significant only for men under 65 years of age. In this age group, only seven men shall be treated to save a life.
More men in the first assigned to the monitoring group saw their cancer spread beyond the prostate, and many of them wound up taking hormonal treatments.
Surgery had side effects - 58 per cent of men reported at least some sexual problems and 32% had urinary problems. Researchers did not report how many men in the monitoring group had these problems, which are common as men age, even if they do not have prostate cancer.
Surgery techniques have improved since the study began, and nerve of the approaches to minimize the side effects are more frequent now.
The study "provided important evidence that effective treatment is necessary and possible for many of the men of prostate cancer, at the stadium" Dr. Matthew r. Smith of Massachusetts General Hospital wrote in an editorial in the journal.
But if the men of benefits of surgery with early cancers detected by PSA tests rather than the symptoms of rest to see, he added.
Two studies, one of the United States and the other in the United Kingdom, are looking at this now and include other options outside the surgery, he noted.
About half of the 218 000 diagnosed at the United States men each year with cancer of the prostate have early, low-risk disease and more choose to deal immediately with surgery, radiation therapy or hormones. In Europe, most choose monitoring and treatment only if the situation is worsening.
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