Prostate Intervention Versus Observation Trial (PIVOT)

A diagnosis of prostate cancer is shocking and most often quite unexpected. The thought of a tumour growing inside you is sickening.  Don’t rush into an operation … it could be the worst thing you do.

Almost immediately, men face a decision about treatment – and the first impulse is, for many, to want it cut out.

As an oncologist with more than 15 years specialising in the condition, you might expect me to agree.

But I urge patients not to be so hasty. Mounting evidence shows that surgery is not always the best treatment. Read Full Text:

SURGERY DOES NOT IMPROVE SURVIVAL

In the Prostate Intervention Versus Observation Trial (PIVOT), Half of the men underwent surgery to remove the prostate – known as ‘radical prostatectomy’ – the others did ‘watchful waiting’, which means they had no immediate treatment.

The results showed that on average those who underwent surgery were no more likely to survive than the watchful waiting group.  Read Full Text:

MEN WITH PROSTATE CANCER FREQUENTLY HAVE NO SYMPTOMS AT ALL

If the PSA levels are high or a change has occurred to the surface of the prostate, a biopsy is performed by taking tissue from the prostate with a needle.

If results come back with a PSA score above 20 or a Gleason score between 8 and 10, it is usually advisable to have immediate treatment. Read Full Text:

ACTIVE SURVEILLANCE MAY BE THE BEST OPTION

In those diagnosed with a PSA score lower than 10 and a Gleason score of 6, I would not normally advise surgery. Instead, I would usually recommend active surveillance – which is a halfway house between watchful waiting (doing nothing) and surgery.  The patient undergoes regular testing – MRI scans, blood tests and biopsies – to monitor the cancer.

Watchful waiting is an option for those who are very elderly or who have other serious medical problems.  Read Full Text:

THE PSYCHOLOGICAL HURDLE

It is important that a man who has been diagnosed with low-risk prostate cancer overcomes the psychological hurdle that he has a cancer inside him. Whether you suffer from low or high-risk cancer, there should be regular dialogue between your doctor, oncologist, urologist and yourself.

Apart from the specialists (oncologist, urologist, radiologist), you need a local doctor you can relate to to supervise your progress towards cure or not.  The specialists are only concerned with the tumour, they have no concern for the patient.

Take time to think over the options available to you as removing the prostate is a life-changing course of action.Read Full Text:

BE PROACTIVE BEFORE MAKING A DECISION

Ensure you check how experienced your surgeon is – they should be doing more than 50 prostate operations a year and you have every right to ask them if this is the case.

Something else that the study highlights is that too many men are being diagnosed with the cancer in the first place.  If low risk prostate cancer does not need any treatment then it does not need to be diagnosed either.

To my mind, when it comes to low risk prostate cancer ignorance really is bliss.

But perhaps the most important fact to be taken away from this recent trial is that if you are diagnosed with prostate cancer, many options are available to you.

Radical prostatectomy is not the only avenue you must explore and your quality of life may not need to be dramatically reduced. Read Full Text:

By DR CHRIS PARKER  UPDATED: 21:04 GMT, 23 June 2012b

*** This is the final article published posthumously on behalf of Greg.