Hundreds of men with prostate cancer may have gone through the trauma of unnecessary surgery – leaving them at risk of impotence, a study has suggested.

Scientists have found that many men with the disease who decide not to go for surgery or other invasive therapies such as radiotherapy fare just as well as those who do choose the treatment.

The mistakes happen because the standard PSA test used to detect prostate cancer is so unreliable that it cannot distinguish between aggressive and mild forms of the disease.

While people with the aggressive or ‘tiger’ form may require surgery or radiotherapy to save their lives, those with mild or ‘pussycat’ cancer can live for years without treatment.

It is hard for doctors to know which is which.

But going for surgery and radiotherapy – as hundreds in Britain do every year – is a risk because they can both leave men impotent and sometimes incontinent.

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Prostate is Britain’s most common cancer among men and the second highest killer, after lung cancer. Some 35,000 people a year are diagnosed with it – and 12,000 die.

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Study leader Dr Martin Sanda, associate professor of surgery at Harvard Medical School, said: ‘With the advent of PSA screening nearly 20 years ago, we started to detect prostate cancers at much earlier stages.

‘Consequently, while PSA testing has enabled us to successfully begin aggressive treatment of high-risk cancers at an earlier stage, it has also result in the diagnosis of cancers that are small they pose no near-term danger and possibly no long-term danger.’

His team studied the health of 51,529 men who they have been following since 1986.

Every two years, the men respond to questionnaires inquiring about diseases and health-related topics, including whether they have been diagnosed with prostate cancer. A total of 3,331 men reported receiving a diagnosis of prostate cancer between 1986 and 2007.

But among this group, 342 men – just over 10 per cent – had opted to defer treatment for one year or longer. Ten to 15 years later, half the men who had initially deferred treatment still had not undergone any treatment for prostate cancer – meaning they had never needed it in the first place.

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September 2, 2009

The Best of Daniel Bates

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