Benefits of prostate therapy questioned.

Older men with slow-growing prostate tumors may get little or no benefit from surgery and radiation therapy, a new report suggest. Such aggressive treatment may help only a select group of prostate cancer patients, primarily young men with fast-growing tumors.

Despite questions about its usefulness, surgery to remove a malignant prostate has become increasingly popular in the United States, according to a second study. Both reports appear in the May 26 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

The prostate is the walnut-sized male sex gland that surrounds the urethra. Treatment for prostate cancer routinely includes surgery, radiation therapy, or both. In some cases, physicians suggest a course of "watchful waiting," which includes checkups to see if the cancer has progressed and treatment for cancer complications such as pain. U.S. clinicians are known to favor the invasive approaches, yet the risk-benefit equations of these options have not been rigorously examined, says Craig Fleming of the Oregon Health Sciences University in Portland.

Fleming and his colleagues designed a computer program that analyzed the benefits and the risks of each treatment option. The analysis considered such variables as quality of life, complications, and gains in longevity.

The findings suggest that for many men with slow-growing prostate tumors, surgery and radiation therapy offer "limited benefits" and can cause debilitating complications, such as impotence and severe incontinence. With or without treatment, most prostate tumors grow slowly. Thus, treatment usually doesn't offer significant longevity benefits, says Fleming. Indeed, chances are good that many men, particularly older men, will die from another cause before prostate cancer kills them, he says.

The analysis suggests that for many men, a less invasive approach may be warranted. Rather than opting for surgery or radiation therapy, says Fleming, men with a slow-growing tumor may want to adopt a wait-and-see approach that includes regular visits to the urologist.

Despite the risks, some patients decide to go ahead with more aggressive treatment, he adds. Men who want surgery often cite the procedure's psychological benefits. For example, notes Fleming, some men say surgery offers peace of mind because they know the malignancy has been removed.

In the second study, John E. Wennberg of Dartmouth Medical School in Hanover, N.H., and his colleagues examined the frequency of surgery for prostate cancer in the United States. They discovered that the rate of radical prostatecomy in 1990 was nearly six times the rate in 1984. Furthermore, the chance of undergoing prostate surgery varied widely according to geographic location. For example, men with prostate cancer who lived on the West Coast were more likely to receive the surgery than their New England peers.

For older men who opt for surgery, the risks of the operation may not be trivial. The analysis indicates that within a month of surgery, almost 2 percent of men over age 74 died and nearly 8 percent suffered major complications.

As with many other medical procedures in common use, the safety and efficacy of surgery and radiation therapy for prostate cancer have not been rigorously assessed, Fleming says. If these treatments had to meet the same standards applied to new drugs by the Food and Drug Administration, the procedures probably wouldn't pass muster, he asserts.

What's a man to do? Scientists are currently conducting two trials to evaluate the safety and efficacy of treatments for prostate cancer, Fleming says, but the results won't be in for years. For now, he suggests, men with prostate cancer should seek out a physician who can advise them on the risks and benefits of the various treatment options.

COPYRIGHT Science Service Inc. 1993