Doctors claim regular check-ups are just as good as surgery and radiotherapy

Thousands of men with early prostate cancer needlessly undergo gruelling surgery and radiotherapy, a study suggests.

Men are just as likely to survive for ten years if they go for regular check-ups rather than rushing into treatment, the research found.

The decade-long study led by Oxford and Bristol universities shows men with localised prostate cancer may not have to endure treatment and its side effects.

Prostate cancer is the most common cancer in men, affecting one in eight at some point in their lives. The study found an approach called ‘active surveillance’ – with blood tests every six months then treatment if the cancer spreads – had the same survival rate as radical treatment.

Experts stressed the results applied only to men whose tumours had not yet spread outside the prostate gland.

But men with slow-growing tumours have time to consider the pros and cons of treatment. Most of these men learn they have prostate cancer through a blood test for raised levels of a protein called prostate-specific antigen (PSA).

Many do not even show symptoms, yet thousands rush into treatment each year. The study, funded by the NHS’s research arm, found 1 per cent of early prostate patients died over ten years – whether they had treatment or not.

Professor Freddie Hamdy, of Oxford University, said: ‘What we have learnt from this study so far is that prostate cancer detected by PSA blood test grows very slowly, and very few men die of it when followed up over a period of ten years – around 1 per cent – irrespective of the treatment assigned. This is considerably lower than anticipated when we started the study.’

I’M SO GLAD I DIDN’T HAVE THE OP
When Robin Porter was diagnosed with prostate cancer ten years ago, he was immediately told to have surgery.

His urologist said removing his entire prostate gland and surrounding tissue was the best option, but the retired lawyer decided to get a second opinion.

Another specialist told him to consider having regular check-ups and the 70-year-old has never required treatment.

The grandfather said: ‘I think many of us, when we hear the word cancer, think we should be cutting it out. But I was advised that because my cancer was at a relatively early stage, it would be perfectly safe to go on to active surveillance. It means that if there is any indication my cancer is getting dangerous, they will act.’

Mr Porter, who lives with wife Shirley in Buckinghamshire, remains fit – cycling, skiing and playing tennis. He said: ‘It has been an excellent decision. I haven’t had the side effects, but I know that because I am being monitored I would be able to have the treatment speedily if it did spread.

‘I suppose the downside is that you do have the stress. Unless you are a very special type of person, you are always thinking, is this the time they will say, “Sorry, you do have to have the operation.”’

Some 47,000 men a year are diagnosed with prostate cancer in the UK, up to 30,000 of them with a localised, low-grade form that has not spread outside the prostate.

About two-thirds with localised prostate cancer have treatment including radiotherapy, surgery or both. But this can have side effects such as impotence, incontinence and bowel problems.

Until now, doctors have been nervous about recommending men do not receive treatment – worried the cancer will later spread rapidly. But co-author Professor Jenny Donovan, of Bristol University, said: ‘If you have cancer which is localised within the prostate, you must not rush into a decision about treatment.’

The researchers found surgery or radiotherapy did reduce the chance of the disease progressing – from about 20 per cent to 10 per cent. But that did not lead to a reduced survival rate over ten years.

Beyond a decade, survival rates may differ – and they are extending the trial to see if that is the case.

But even if mortality rates change later in life, researchers said patients should weigh that against the side effects of treatment. Professor Donovan said: ‘It should be a decision for men and their families about what matters most in their lives.’

The research team, whose results were published in the New England Journal of Medicine, tested 82,429 men aged 50 to 69 for prostate cancer in the late 1990s.

Of these, 1,643 were diagnosed with localised prostate cancer. They were split into three groups – one set had surgery, one received radiotherapy, and one underwent ‘active surveillance’. Half of those being monitored later showed signs the cancer was spreading and were treated. But the other half avoided treatment completely.

No matter the treatment, 99 per cent survived. Professor Hamdy said: ‘The conversation now between doctors and patients will be much better informed than in the past.’

Dr Matthew Hobbs, from Prostate Cancer UK, said the findings were ‘hugely positive’.

And Professor Sir John Burn, of Newcastle University, said the findings were ‘valuable information for men faced with difficult choices’.

Written by Ben Spencer, Medical Correspondent for The Daily Mail. ~ September 14, 2016.

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