A study of early-stage prostate cancer patients sees no statistical difference in mortality between those who undergo treatment surgery and those who don't.

This finding, published in the July 19 edition of the New England Journal of Medicine, is leading researchers to speculate that forgoing prostate removal surgery in favor of continuing observation may be a wiser option, particularly since the risks of radical prostatectomy include impotence and incontinence and since most prostate cancer diagnoses are not fatal.

"Many men, when they hear about a diagnosis of prostate cancer, become fearful. They think if they aren't treated they will die from it," says Timothy J. Wilt, MD, MPH, of the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, who co-authored the study. "Our results clearly demonstrate that's not true. The overwhelming majority will not die of their disease if it's left untreated."

For the study, the researchers followed the cases of 731 men (average age: 67 years), each of whom had been diagnosed with early-stage cancer after a prostate-specific antigen test, over more than a decade. About half underwent surgical treatment, while the other half did not.

A little less than half of the patients (48.4%, or 354) died during the course of the study, but the deaths were divided evenly between the 2 groups: 47% of the surgery patients (171 of 364) and 49% of the non-surgery group (183 of 367).

"Among men with localized prostate cancer detected during the early era of PSA testing," says the study, "radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up."

David Bernard