Prostate cancer: OP often not justified

In Germany, the majority of patients are still operated on with localized prostate cancer. The fact that this procedure has long since become obsolete is demonstrated once again by a study recently published in the renowned specialist journal "European Urology". According to the study, men with a low risk tumor or men older than 70 years of age are not well advised to have an operation. On the contrary: The operation is sometimes associated with considerable side effects.

Thanks to improved early detection, more and more prostate carcinomas are being detected at an early stage. At the same time, there is growing uncertainty as to whether all diagnosed tumours actually require invasive therapy, such as radical surgery. It is now known that many of these tumours would never cause symptoms, let alone lead to death. Swedish and US-American scientists have now tried to clarify in a model calculation for which men with a tumor limited to the prostate can actually benefit from the operation and for which men not. To this end, they examined data from a total of 695 men who were either operated on or whose tumor was actively monitored without treatment (Active Surveillance).

Questionable benefit of the operation

The study2 showed that the majority of men do not benefit from the operation as previously assumed.         According to the scientists, the benefit of surgery cannot be clearly demonstrated even for patients whose tumor condition is less favourable_GO which can be treated with Gleason-Score 7 and T2 tumor with Gleason-Score 6). Unlike young men who have an aggressive tumor. The risk of dying from prostate cancer is reduced by invasive therapy.

This raises the question of whether a radical approach to treatment is justified in any case? It does not make much sense to remove the prostate completely,"said Dr. Derakhshani, urologist at the West German Prostate Center," because of the favorable nature of the tumor or its age, it makes little sense to remove the prostate completely. A radical prostate surgery is the wrong approach, especially as the procedure can be associated with considerable side effects. Up to 50 percent of those undergoing surgery suffer from stress incontinence and 30 to 100 percent from erectile dysfunction1.

If at all, the aim of treatment should be to achieve the best possible cure with the least side effects. Minimally invasive therapy methods such as internal radiation are particularly suitable for this purpose. In so-called brachytherapy, the smallest radiation sources are brought directly into the prostate under ultrasound control. Brachytherapy thus has a major advantage over surgery:"By exactly distributing the radiation dose, we can irradiate the tumour without damaging surrounding structures such as the urethra or sphincter," said Dr. Derakhshani.

In addition, the urologist emphasizes the equivalence of brachytherapy compared to surgery in terms of the healing rate. For example, a recent metastudy3 has shown that brachytherapy alone or in combination with complementary radiotherapy or hormone therapy is at least equivalent or even better in all stages of localized prostate cancer compared to radical surgery. This allows the patient to combine the advantage of optimal tumor healing with the fewer side effects compared to surgery,"summarizes Derakhshani.

Literature:

Naselli A, Simone G, Papalia R, Gallucci M, Introini C, Andreatta R, Puppo P: Late-onset incontinence in a cohort of radical prostatectomy patients. Int J Urol. 2011 Jan; 18 (1): 76-9.
Vickers A, Bennette C, Steineck G, Adami HO, Johansson JE, Bill-Axelson A, Palm-gren J, Garmo H, Holmberg L.: Individualized Estimation of the Benefit of Radical Prostatectomy from the Scandinavian Prostate Cancer Group Randomized Trial. Eur Urol. 2012 Apr 19.[Epub ahead of print]
Grimm P, Ignace Billiet I, Bostwick D et al. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJUI 109, Suppl. 1,22-29,2012hen associated side effects.

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