I’m 60 years old and have been diagnosed with prostate cancer. The doctors say mine is early-stage, and my prostate-specific antigen (PSA)
Prostate Cancer Surgery
By Peter N. Landless and Allan R. Handysides
I’m 60 years old and have been diagnosed with prostate cancer. The doctors say mine is early-stage, and my prostate-specific antigen (PSA) test result was only 15. I’ve been recommended to undergo a radical prostatectomy. What is your opinion?
When we write these columns, we do not write as experts in everything; rather, we attempt to bring you current opinions as expressed in recent literature. We must stress to you—and all our readers—that your best advisors are the competent health-care professionals who know you best. We write, therefore, in generalities.
Prostate cancer is a subject of great concern because it’s such a prevalent condition. As the population lives longer, diseases of old age have become more common. Prostate cancer was found to be present in microscopic forms in nearly 100 percent of men over 80 years of age in an autopsy study done many years ago.
The question of management, however, is not in the over 70- or 75-year-old population, but in younger men. As a 60-year-old, you’re presumably still active and robust, and still working. You could have many productive years ahead of you.
The options for your management include surgery, as has been recommended; various forms of radiation; or combinations of both plans with even added chemotherapy where needed.
Many men are concerned about the side effects of surgery, such as urinary incontinence or erectile dysfunction.
Not all prostate cancer is equally aggressive, and pathologists will come up with an aggression score called the “Gleason score.” Highly aggressive tumors require aggressive treatment. Older men over 75 years of age might well die of causes other than prostate cancer, and this situation has to be weighed against potential risks. This has led to the concept of “watchful waiting.” Persons in the 65- to 74-year-old age group are a little more difficult to advise. Seeing that you are young (60), we’re of the opinion that you’re being offered appropriate advice.
We found a recent article that studied the benefits of radical prostatectomy over the long term, and compared it with watchful waiting. This Scandinavian study* followed 695 men from between 1989 and 1999, through 2012. This period of up to 23 years of follow-up permitted the two groups—347 men in the surgery group and 348 men in the watchful-waiting group—to be studied.
Two hundred men in the surgery group died, and 247 in the watchful-waiting group died. Deaths due to prostate cancer were 63 in the surgery group, and 99 in the watchful-waiting group.
This study shows benefits of the surgery; however, the benefits were more in the younger men. The outcomes in the older men in the watchful-waiting group who never required palliative treatment provided support for the concept of active surveillance in adequately selected groups. In this study the overall long-term disease burden is a reminder that factors other than survival need to be considered when counseling individual men with prostate cancer.
We do agree with your medical/surgical team and believe your chances of cure to be quite high with surgery. You might be offered additional measures, or even the very precise robotic surgical approach.
Though side effects are certainly common and not to be minimized, your survival, even with some side effects, could be vastly superior to the alternative of nonevidence-based approaches, including not being treated at all.
*Anna Bill-Axelson et al., “Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer,” New England Journal of Medicine 370, no 10 (March 6, 2014): 932-942.
Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department.
Allan R. Handysides, a board-certified gynecologist, is a former director of the General Conference Health Ministries Department.