A recent study of 1000 men with milder forms prostate cancer has questioned the benefits of aggressive treatment (read surgery) in patients with milder stages of disease. The conclusion of the study is that surgical treatment (removal of the prostate) does not prevent cancer deaths in this low risk group.
Despite the claims of this study, the conclusions are considered more uncertain than perhaps the headlines would suggest. The reasons for this uncertainty include a variety of factors:
This study has been ongoing since 1994 and so it emcompasses a variety of different treatment approaches during that timeframe, as patterns of treatment have changed over the past 18 years.
The study was meant to enroll 2000 patients, but stopped at 940 due to a slowness in recruitment for study. This affects the statistical validity of the findings.
The study was meant to determine if there was ‘at least’ a 25% difference in treatment result between the two approaches, but may miss differences that are less than 25%.
For many reasons, I think this study is important, but of uncertain significance. Primarily, it suggests that the differences between various approaches (aggressive vs. non-aggressive) may be less than we assume. Although it does not prove that ‘watch and wait’ is as good as surgery, it shows that the differences may not be as vast as one would presume, and this can give heart to those who would rather pursue a conservative approach.