Study: Observation as Good as Surgery in Early-stage Prostate Cancer

middle aged male patient talks with his doctor in an exam room

A major 20-year study led by the Minneapolis Veterans Affairs Health Care System has found more evidence that surgery for early-stage prostate cancer does not help men live longer than observation. Observation, sometimes called watchful waiting, means doctors monitor a man’s prostate cancer over time to make sure it’s not getting worse, and only then consider surgery or other active treatment. This is a good option for many men because most prostate cancers grow very slowly and may never cause health problems.

The study, which included research teams from across the US, used data from the Prostate Cancer Intervention Versus Observation Trial (PIVOT). It compared treatment with surgery to treatment with observation in 731 men with prostate cancer that had not spread beyond the prostate. About half the men – 364 – were assigned to surgery to remove the prostate. The other half – 367 – were assigned to observation. The men in the observation group received surgery or other active treatment only if tests or symptoms indicated their prostate cancer might be growing.

When the PIVOT study began in 1994, the average age of the men was 67. After 20 years of follow-up, 61% of men in the surgery group had died; 7% of them died from prostate cancer. In the observation group, 67% of them died; 11% from prostate cancer. The differences between the two groups are not significant.

However, the men in the surgery group were more likely to have side effects that needed treatment. In the surgery group, 17% reported urinary incontinence compared with 4% of the observation group, and 15% reported erectile dysfunction compared with 5% of the observation group. The study was published July 13, 2017 in the New England Journal of Medicine.

Key takeaways

Some previous studies have also found no difference in survival between men who have surgery and men who use observation. However, others have found that those who have surgery might live longer. According to the study’s authors, the combined results from the studies show:

  • Long-term, death from prostate cancer is low among men with early-stage prostate cancer who are treated with observation.
  • Men with intermediate-risk prostate cancer who have long life expectancies are more likely to see a survival benefit from surgery.
  • Even though men with high-risk disease may have a poor prognosis, surgery may not help them live any longer.
  • Surgery seems to help keep the cancer from coming back, but most cancer recurrences don’t cause problems. Therefore, the benefits of slowing cancer growth through surgery are unclear.
  • Long-term side effects from surgery can include incontinence, erection problems, and other complications, some requiring treatment. 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. Published July 13, 2017 in the New England Journal of Medicine. First author Timothy J. Wilt, MD, MPH, Minneapolis Veterans Affairs Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis.

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