What's the best treatment for prostate cancer?
Dr Mark Porter on whether treatment is always necessary for certain types of prostate cancer.
Image credit: Getty/Ryan McVay
Dr Mark Porter on whether treatment is always necessary for certain types of prostate cancer.
I’m worried about my brother, who has been diagnosed with prostate cancer.
Despite it being caught early he has decided against surgery or radiotherapy. He is 76 and in good shape and I think he’s in denial.
What surprised me most is that the specialist seems to support his decision. Surely it’s better to get the cancer out? Or has my brother just been written off due to pressures on the NHS?
No he has not, and I hope that by the time you read this your brother will have the opportunity to explain that this is an increasingly common option these days when dealing with early, less aggressive prostate cancers.
To be blunt, most men his age will die with the condition, rather than because of it, and radical treatments like surgery or radiotherapy can, in some cases, cause more problems than they solve.
I know this is counterintuitive, but prostate cancer is often (not always) much less of a threat than other types and, following careful assessment using scans and biopsies, these ‘pussy cats’ can often be monitored safely for many years.
On the other hand, the less common aggressive ‘tigers’ do need prompt and radical treatment.
The difficult bit is differentiating between the two – something we are getting better at but have yet to perfect.
The UK is a world leader in research into the best option for men in your brother’s situation and the latest results of a long-term trial following nearly 2,000 men with the disease are very reassuring.
The men who agreed to take part in the ProtecT study were randomly allocated to three groups: one underwent surgery, another radiotherapy and the last had active surveillance (no active treatment but regular blood tests and scans where required). Fifteen years later and deaths from prostate cancer have been comparatively rare in all three groups.
While 356 men died during this period, just 45 of those deaths were due to prostate cancer. And the risk of dying from prostate cancer was similar in each of the three groups: 12 men (2.2%) who had their prostates removed died from the disease, compared to 16 (2.9%) in the radiotherapy group and 17 (3.1%) in those who were actively monitored.
Of course, some men in the active monitoring group did go on to receive treatment too – either hormone injections, surgery or radiotherapy – but only after their regular PSA tests and review suggested their cancer was growing or changing in a way that required a more aggressive approach.
Early surgery and radiotherapy do save lives but often at a significant cost to many other men.
Or to put it another way, we probably have to treat at least 20 men with surgery or radiotherapy to save one life: great if you are that one man whose life was saved, but not so clever if you are one of the other 19 left with side effects from treatment you may never have needed.
So, I don’t believe your brother is in denial, but rather I am hoping he has just listened to the options presented by the specialist and chosen what suits him, on the understanding that he will be closely monitored going forward in case anything changes.
On a different note, the fact that he has prostate cancer does put you at higher risk, so you should talk to your doctor about the pros and cons of screening using the PSA blood test.
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