27 April 2012
Cancer specialists are bracing themselves for publication of a research study that will challenge the way one of the commonest cancers is treated. The world's biggest randomised trial of prostate cancer has found that the standard surgical treatment for the disease is ineffective.
The study compared 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 not to be named, said: "The only rational response to these results is, when presented with a patient with prostate cancer, to do nothing."
Cancer of the prostate is the commonest male cancer affecting 37,000 men a year in the UK and causing 10,000 deaths.
But in up to 50 per cent of cases it 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 results of the Prostate Intervention Versus Observation Trial (PIVOT), led by Timothy Wilt and started in 1994 with 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. The difference was not statistically significant and could have arisen by chance.
When the findings were presented at a meeting of the European Association of Urology in Paris in February, attended by 11,000 specialists from around the world, they were greeted with a stunned silence.
One expert who attended the meeting said that 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]."
Prostate cancers are already classified as "tigers" (aggressive) or "pussy cats" (low risk). But some urologists who have spent years training to perform complex surgical techniques find the idea of watchful waiting unacceptable.
Surgery 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.