The first hints of concern over using PSA began at least 7 years ago. Since then, how many have undergoing prostate cancer surgery thinking it was the only option?
I have covered the controversy surrounding PSA screening in previous blog posts that can be read here.
In an all-too-typical scenario, a 50 year old man has his PSA levels checked during a routine office visit. When it comes back elevated, the cascade of additional testing begins, ultimately leading to the recommendation for a radical prostatectomy.
From an emotional standpoint, this sounds like the best option. You have cancer. You want it out. Decision made.
If, however, we were to take a step back and approach the problem statistically and logically, the answer may look very different.
This particular study compares the long term outcomes (median 10 years) of radical prostatectomy versus observation in a group of 731 men diagnosed with prostate cancer. Here are the findings:
- 47.0% of those who had radical prostatectomy died
- 49.9% assigned to observation died
- In the prostate surgery group, 5.8% died from prostate cancer or treatment
- In the observation group, this number was 8.4%
- Radical prostatectomy was associated with reduced overall death rate among men with a PSA value greater than 10 ng per milliliter or with an intermediate-risk or high-risk tumor
- Adverse events within 30 days after surgery occurred in 21.4%, including one death
There are a few take home messages here.
- There was a benefit to prostate surgery, but it was very small (2.9%)
- This of course does not go into the potential risks of surgery such as impotence, which can massively affect quality of life
- We can tease apart those who may benefit more from radical prostatectomy
- But, the biggest factor here is…………………
This was all done in the context of “standard of care,” which generally does NOT INCLUDE LIFESTYLE RECOMMENDATIONS TO FURTHER LOWER RISK!!!!
So, what would happen if those who opted for observation made significant lifestyle changes that have been associated in the medical research as lowering the risk for or improving the outcomes?
You can bet these results would’ve looked much, much different.
So, if you have been diagnosed with prostate cancer, read the current prostate cancer news and decided to forgo radical prostatectomy, what lifestyle changes did you make along with your decision?