Prostate cancer is too often operated

Recent studies confirm over-therapy / Serious surgical consequences for patients

In Germany, the majority of patients are still operated on with localized prostate cancer. Numerous studies show that this procedure has long since become obsolete. Especially men with a low risk tumor or men over 70 years of age are not well advised to have an operation. On the contrary, many patients complain about significant side effects and late effects of the procedure. And this despite the fact that more and more vascular and n-valve-friendly surgical techniques are being used.

It is a fact that 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. Unfortunately, the use of a scalpel happens far too often,"criticizes Dr. Stephan Neubauer, a urologist at the West German Prostate Center. Prematurely, men would be operated on with prostate cancer without even considering more gentle treatment options or even controlled waiting (Active Surveillance).

More damage than benefit

Numerous studies, including a recent study1 published in the New England Journal of Medicine, confirm the thesis that too many men are operated on with prostate cancer without benefiting from it in the long term. On the contrary, the proportion of men who have become incontinent (17 versus 6%) or impotent (81 versus 44%) within two years is significantly higher in the case of those who have undergone surgery than in the case of those who have not undergone surgery. 

A recently published study by the Barmer GEK2 health insurance fund came to similar results, according to which 70 per cent of the operated patients complained about erectile dysfunction, 53 per cent about sexual disinterest and around 16 per cent about urinary incontinence. In addition, one in five confirmed surgical complications such as severe bleeding or intestinal injuries. 

In many cases, a radical removal of the prostate gland does not prolong life, but in case of doubt the quality of life is massively restricted,"summarizes Dr. Neubauer. In view of the current study situation, the question arises whether a radical treatment approach is justified in any case? Instead, the goal 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 significant 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. Neubauer.

Current Metastudy: Brachytherapy of the OR superior

Brachytherapy is not only convincing in terms of its efficacy due to its lower number of complications: a current meta-study (collection of worldwide study data) has been able to prove for the first time that brachytherapy, al-lein or in combination with complementary radiotherapy or hormone therapy, achieves at least equivalent or better healing rates in all stages of the disease compared to radical surgery. As a result, the patient can sensibly combine the advantage of optimal tumor healing in brachytherapy with the fewer side effects compared to surgery,"said Neubauer.

Literature:

Wilt TJ, Brawer MK, Jones KM et al.; Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012 Jul 19;367 (3): 203-13.


Barmer GEK Hospital Report 2012


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 Res

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