Older men with early-stage prostate cancer may be better off waiting and having regular checkups and tests to monitor their cancer than having surgery or radiation therapy, says a new report.
The study in yesterday's Journal of the American Medical Association is likely to stir controversy among doctors and the public about the effectiveness of surgery and radiation to treat prostate cancer, the most common kind of cancer among American men.
Surgery and radiation for men older than 60 with early stages of prostate cancer may not help them live longer and may put them at risk for complications, particularly impotence and incontinence, which may "severely degrade quality of life," the study said.
"It's going to cause a real furor," said Dr. Fred Lee, an adviser to the American Cancer Society on prostate cancer. He directs the Prostate Center at Crittenton Hospital in Rochester, Mich.
"This paper is good in educating consumers that doing nothing may be the best way to go in dealing with prostate cancer in Grandfather," added Ananias Diokno, chief of urology at William Beaumont Hospital in Royal Oak, Mich.
He said he advises men older than 65 not to have the surgery, but many insist on it. "I think the problem is that the geriatric population is getting younger and younger, and they and their families are demanding to be treated like much younger persons."
In fact, in a separate study in the journal, Dartmouth Medical School researchers found that the number of prostate operations among men 65 and older rose from 2,600 in 1984 to 16,000 in 1990.
The JAMA report reviews 1,600 studies in research of surgery or radiation for men ages 60 to 75.
Surgery and radiation are especially questionable for men older than 75, who are more likely to die from causes other than their prostate cancer. The reason is that many prostate cancers grow slowly, the report said.
Surgery also is costly -- up to $25,000 in some parts of the United States -- and fraught with complications, said Dr. Craig Fleming and a team of researchers. They found these major complications:
* Impotence occurs in about 44 percent of men after radiation therapy and in 30 percent to 60 percent after surgery, depending on whether new nerve-sparing techniques are used.
* Permanent incontinence occurs in about 1 percent of men after radiation and in 6 percent after surgery. Many others develop so-called stress incontinence, which causes urine to leak when they cough, sneeze or laugh. Exercises can help them regain bladder control.
Research is so inadequate that men don't know whether waiting is better than other options, Dr. Fleming said in a telephone interview.
A few studies under way should answer questions about which treatment options, if any, are better than waiting, he said.