Specialising in the human experience of Living with prostate cancer – warts and all

Early PCa surgery does not save lives

with 6 comments

When most men are told they have prostate cancer, their immediate thought is, ‘Oh my God, I’m going to die,’ and their immediate next step is, ‘Let’s do something about this.’ By then, the idea of an observation approach is lost.”  But wait …  It seems that is not the best way to go early in the piece.  The following articles see it differently.

Surgery for early-stage prostate cancer ‘not saving lives’

Brisbane Times

A LANDMARK study of prostate cancer surgery has found it does not appear to save the lives of men with low-risk disease and causes high rates of incontinence and erectile dysfunction. In what has been described by experts as ”game changing”

The number of Australian men having PSA (prostate specific antigen) tests and surgery for prostate cancer has increased dramatically over the past decade as high-profile men such as Sam Newman and Alan Jones have publicised their prostate cancer diagnoses.

In the study’s surgery group, one in five men suffered a complication from the surgery called a radical prostatectomy. Two years on from the procedure, one man had died from it, 81 per cent suffered erectile dysfunction, 17 per cent had urinary incontinence and 12 per cent bowel dysfunction. In the observation group, 44 per cent had erectile dysfunction, 6 per cent urinary incontinence and 11 per cent bowel dysfunction.
Because it is difficult to tell which of the remaining cancers will progress to cause trouble or not, many men are choosing treatments that can cause them harm, including thousands who choose surgery.

Many men with prostate cancer can avoid early surgery
Active surveillance is apt to be better than observation or immediate treatment
in most low-risk patients,” says Andriole, who follows several hundred patients at Washington University who have opted for close monitoring rather than treatment soon after their diagnosis. “We watch the PSA very closely and biopsy men periodically, so if a tumor starts growing or becomes more aggressive, we can still successfully treat it.”

But the findings indicate that surgery did reduce mortality in two groups of men – those with relatively high PSA levels (greater than 10 ng/mL) and potentially those with higher-risk, more aggressive tumors. 

Prostate Cancer: New Study Challenges Value of Surgery
“The real conclusion that they got was that older men with low-risk cancers can be observed for at least eight years,” he said. “But we knew that — that’s not new information.”

10 Years to Live? Get the PSA Test For Prostate Cancer
Sacramento Bee
Beyond life expectancy, Dr. Samadi knows firsthand that quality of life is a stronger factor for many. “I have performed successful robotic prostatectomy surgery on many patients in their late 70’s. While some experts might suggest they had a medical life expectancy of less than ten years, these men chose peace of mind,” he says, “For most patients, my robotic SMART (Samadi Modified Advanced Robotic Technique) surgery can deliver that and quality of life at any age.”

Read more here:

Surgery unnecessary for most prostate cancer
Minneapolis Star Tribune (blog)

However, nearly twice as many men who had surgery reported incontinence and impotence after two years, researchers report in the New England Journal of Medicine.

The results suggest that many men who have received surgery in the past probably didn’t need it. “I don’t think there’s any question that many of those cancers were overtreated,” said Brooks, who stressed that there is no way to know on an individual basis.
The debate over prostate cancer is turning to prostate cancer surgery: if it’s really worth it or not.


6 Responses

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  1. Greg: its Lee. I had no idea you were working on this piece, I had been about to cover similar ground in my next post from a personal point of view. and rather than go over my point of view here I should continue to write my post as an addendum to your piece here. Great work this, as you have managed to include some statistics. When i decided to run my personal piece I was amazed at the lack of any real and cohesive statistics on the side effects of incontinence and erectile problems experienced by men undergoing surgery or radiation treatment. Most of the information found on web sites include a lot of spin and include figures such as between 5 % and 80% of men experience this or that and three years later 5% experience this or that blah blah blah. I was pointed to a book called “Let Sleeping Dogs Lie” which is a PDF booklet available on the university of Sydney web site, This information was brought to my attention by Peter who left some comments on a previous post of yours. Peter was not very much in love with this book and was critical of the content as it was anti prostate cancer screening. I have read the content a couple of times and I must say I do not share Peters convictions on this work. Enough of that for the moment as I will follow it through from my personal point of view in my next post. Greg- good stuff, lets see if any one else enters the debate.

    Lee aka Popeye


    22 July 2012 at 11:10 pm

    • Please go ahead and add an addendum. The more knowledge we have the better we can make our choices.

      You might notice, some of my articles are of little value to me because of my advanced state. However, they are gently guiding you and others like you to eke out more information.

      Greg Naylor

      23 July 2012 at 12:11 am

      • Greg: Well noted. I have begun the draft already as you will be able to view in the drafts. It is only the begining but you will see where I am going with it. I am running out of steam and am about to turn in for the night. I will call you hopefully sometime later today.


        23 July 2012 at 12:16 am

      • “let-Sleeping-Dogs-Lie” seems to have been written at the bequest of the Govt. in order to convince men that treatment did little, and hence, that PSA testing, was unwarranted… (as lee reports)

        Every man that I know, having undergone RP (robotic prostatectomy) has significant ED (Erectile Disfunction), but each has said, “We are happier, just knowing that it’s GONE.

        So, when the surgeon says — “I can give a 95% guarantee of total cure through RP…”, do you sit back and say, “ manhood is at risk here… I’ll wait and see..”.
        Do you wait six months, or six years, and when a UrologyDoc declares – “I think it’s time”, you then have to contend with the stronger possibility that it’s PAST time..
        Many men are Bx’ed (Biopsied) with G6, but when RP’ed it’s a G7 (Gleason)..(just weeks later).

        This is a significant risk cancer, as I understand it.

        So, if the the men I know had been convinced that G6 was time-survivable, what would their outcome have been. We are talking No-Problem, Non-Palpable PC, detected solely by PSA rise. The irony is that there is just so much good-info in that book..

        All PC candidates should understand it backwards.

        The reality hits home on page 80, where there is a real analysis of the disabilities of the various treatments after three years. The bottom line seems to be that there is little difference in ED etc.

        Surgery removes, and Radiation Destroys..

        Only LowDose BT (brachytherapy) has minimal effect, but one would assume the LD-BT meant low risk..

        We are all different, but I suspect that we ALL have as our first wish – “To see the Grand Kidz grow up”

        I am happy to just see “Grand-Kidz”… Surviving 10yrs past PC, is pure respite. I, like many, just wonder how we would feel in Greg’s shoes, and if given the choice, we had chosen BR-performance over guarantee. We applaud Greg for his brave stance, and we pray for him.

        I am fairly new here, and I understand that early choice was not on Greg’s Calender. Do I regret not being able to roll-over at 9pm and say “how about it”… Too bloody right, but I rolled over and gave her a kiss. Do I regret not having had radiation – No Way – Radiation that destroys, CAUSES cancer.. Gee, I am worried about all the XRay and CT scans in a short time, trying to detect and cure the bloody cancer itself..

        Is PC more prevalent TODAY – My belief – Hell Yes…

        Is it because it is being detected more or because it is getting worse..?
        Well I believe it’s the dawn of cancer, brought on by the force-grown-foods we eat and the lives we live, and the nasties being sprayed into the air over our heads.


        23 July 2012 at 12:01 pm

  2. My cancer had spread to the bones before diagnosis. Thus, curative treatments were not available to me.

    I had a TURP that did not leave me with any limitations except ED. It seems I had a good Urology surgeon working on me even though he never discussed the down side at all. I found out about the ED from another patient that, in removing everything from the prostate, my ejaculate would backfire into the bladder – a strange sensation.

    More difficult to accept was that upon erection, there was no elongation of the penis. With a maximum length less than half what it was in its glory days, I am too pissed off to attempt penetration. Fortunately, my wife understands and, bless her, she does not complain about the loss of our lovemaking by that method.

    Fortunately, there are other ways to achieve sexual satisfaction but, in my weakened condition, sex has been replaced with holding hands.

    Looking back, I am pleased that I did not have to face the evil side effects of surgery, chemotherapy, or radiation on top of those from ADT or Hormone Therapy.

    Greg Naylor

    23 July 2012 at 2:03 pm

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