Surgery not always best for prostate

AUSTRALIAN prostate cancer patients can be reassured by a major new study that shows surgery is not necessarily their best option, an expert says.

Findings of the PIVOT (Prostate Intervention Versus Observation Trial) study, which followed 731 men with prostate cancers over a 12-year period, were presented recently at the European Association of Urology congress in Paris.

The study, as yet unpublished and criticised by some clinicians for lacking detail, found that in almost half of the cases the tumour was slow-growing enough that patients, left untreated, could live for many years and die from something else.

This supported the stance of the Urological Society of Australia and New Zealand, a spokesman said.

Associate Professor Mark Frydenberg, chair of the society’s Urologic Oncology Special Advisory Group, said: “Men with low risk prostate cancer should be seriously considered for active surveillance, not surgery or other forms of treatment.

“While in some other countries, particularly the US, there has been concern about overtreatment of prostate cancer, Australian urologists will do their best to balance the potential mortality benefits of treatments versus the potential side effects.”

Around 20,000 Australian men are diagnosed with prostate cancer each year, with more than 3000 dying from the disease.

Dr Frydenberg described the PIVOT study as a “terrific bit of evidence” and recently presented findings from his own active surveillance program at the Department of Urology, Monash Medical Centre.

Of 256 men diagnosed with prostate cancer undergoing active surveillance, two-thirds had avoided treatment after four years.

Most men in the study that progressed to treatment did so following repeat biopsies that demonstrated the cancer had increased in size and aggression, with only 14% due to prostate specific antigen (PSA) progression and a further 11% electing to opt out due to anxiety.

He added: “The PIVOT study also showed that high risk prostate cancer, treated surgically, led to a reduced prostate cancer mortality. This is further evidence that early treatment of men with higher risk prostate cancer at the time of diagnosis will save lives."