Cancer specialists are bracing themselves for publication of a research study that will possibly change the way of prostate cancer treatment. The world’s biggest randomised trial of prostate cancer has found that the standard surgical treatment for the disease is ineffective, reports Independent.
The study is based on the comparison between surgical removal of the prostate gland – radical prostatectomy – with “watchful waiting” (doing nothing). The results show that surgery did not extend life.
A leading British specialist, who asked to remain anonymous, explained: “The only rational response to these results is, when presented with a patient with prostate cancer, to do nothing.”
The cancer, which causes 10,000 deaths every year in Britain, in up to 50 per cent of cases is slow-growing so that patients affected, even when left untreated, can live for many years and die of something else.
Some specialists are beginning to question whether these cases qualify for the label “cancer” at all.
The findings of the Prostate Intervention Versus Observation Trial (PIVOT), headed by Timothy Wilt who examined 731 men, showed that those who underwent the operation had less than a three per cent survival benefit compared with those who had no treatment, after being followed up for 12 years.
When the results of the Trial were announced at a meeting of the European Association of Urology in Paris in February, which gathered 11,000 specialists from around the world, they were greeted with a stunned silence.
One expert said that time, while most research results are immediately transmitted by specialists in the audience using social media, “I did not see any urologists enthusiastically tweeting about [this one].”
The most common way of treatment for prostate cancer is surgery that carries a risk of side effects that can have a serious impact on quality of life with 50 per cent of men suffering impotence and 10 per cent incontinence.
Ben Challacombe, consultant urologist at Guys and St Thomas’ NHS Trust, disagreed with the analysis that the response should be to do nothing. He noted that many of the men in the trial were older, with an average age of 67, low risk and would not have been offered surgery in the UK.
“We would offer milder treatment such as radiotherapy or watchful waiting. We are better than the US in putting men on surveillance,” the expert said.
Some specialists believe that treatment is at the stage where breast cancer was a generation ago when the only surgical treatment was mastectomy, removal of the whole breast.
Nowadays women suffering breast cancer are treated with lumpectomy, that means surgical removal of the tumour, leaving the rest of the breast intact.
Some urologists insist a similar approach in prostate cancer could improve survival and reduce the risk of side effects because a smaller proportion of the prostate gland would be targeted and surrounding tissue left unaffected.
However, critics say there is not enough evidence to justify targeted therapy. Dr Kate Holmes, head of research at The Prostate Cancer Charity, said: “Early data from the PIVOT trial certainly suggests that surgery to remove the prostate does not provide any significant survival benefit for men with low to medium risk prostate cancer.”
She added: “However, these findings are from a large ongoing trial, and we look forward to seeing the full published results which could help men in future to make more informed decisions about treatment.”