Page 28 - ARUBA TODAY

A28 SCIENCE
Thursday 13 July 2017

Science Says: Not all cancers need treatment right away

By MARILYNN MARCHIONE answer that. Doctors as- said. The rest were prompt-
AP Chief Medical Writer signed 731 men to observa- ed by signs of progression.
The biopsy shows cancer, tion or surgery. After a de- Surgery also may have im-
so you have to act fast, cade, survival rates were proved survival for men in
right? Not necessarily, if it’s similar, but doctors wanted the middle range of risk,
a prostate tumor. longer follow-up. with PSA levels between
Men increasingly have Now, after 20 years, two 10 and 20, and a Gleason
choices if their cancer is thirds of these men have score (a measure of how
found at an early stage, died and the original con- aggressive cancer cells
as most cases in the U.S. clusions still stand, though look under a microscope)
are. They can treat it right the numbers leaned in sur- of 7.
away or monitor with peri- gery’s favor. Fewer men Only about one quarter to
odic tests and treat later if died in the surgery group, one third of men in the U.S.
it worsens or causes symp- but the difference was fall in this category, though.
toms. small enough that it could Most men are early stage
Now, long-term results are have been due to chance. and low risk.
in from one of the few stud- In this Oct. 13, 2009 file photo, a surgeon performs robotic pros- Only about 9 percent of “Surgery is right for the right
ies comparing these op- tate surgery on a patient in Chicago. men ultimately died from person, and it’s somebody
tions in men with tumors Associated Press prostate cancer, showing with intermediate-risk dis-
confined to the prostate. how relatively seldom the ease,” Andriole said.
After 20 years, death rates Here’s what this and other a chance to treat and po- disease proves fatal. SIDE EFFECTS
were roughly similar for studies tell us about who tentially cure it if it starts to Results are in Thursday’s Surgery had more side ef-
those who had immediate does and doesn’t benefit worsen, Andriole said. New England Journal of fects — 15 percent of men
surgery and those initially from surgery. WHAT THE EVIDENCE SAYS Medicine. in that group later sought
assigned to monitoring, WHY NOT TREAT EVERYONE? Only a few studies have DID SURGERY DO ANY treatment for trouble hav-
and surgery had more side Start with a fact many find tested monitoring ver- GOOD? ing sex, and 17 percent, for
effects. hard to accept: Not all sus immediate treatment. Yes. Fewer men in the sur- incontinence. The numbers
“Many men, when they cancers are destined to kill. One found no difference gery group later had treat- were 5 percent and 4 per-
hear the word cancer, Some prostate tumors are in death rates after more ment because there were cent, respectively, of men
you want to do something deadly, but most grow so than 20 years; another signs the disease might be assigned to observation.
about it,” said one study slowly that men will die of found surgery improved worsening — 34 percent, “You can’t divorce qual-
leader, Dr. Gerald Andriole, something else. survival odds, but only for versus 60 percent of the ity of life outcomes from
urology chief at Washing- Treatments — surgery, ra- men under 65. group assigned to monitor- cancer outcomes because
ton University in St. Louis, diation or hormone therapy Those were done before ing. In many cases, it was they both count for pa-
Missouri. “The reality is, if — can cause impotence, wide use of PSA blood prompted by rising PSA lev- tients,” said Dr. David Pen-
you have a low-risk cancer, incontinence, infections tests, back when more tu- els, but surgery also clearly son, Vanderbilt University’s
like the study shows, you and other problems, and mors were found because prevented more cases urology chief, who had no
don’t need treatment, cer- sometimes do more harm they caused symptoms, from spreading throughout role in the study.
tainly not urgently.” than the disease ever which often means more the body. “Some guys will look at this
It’s not all black and white, would. advanced disease. Half of the group assigned and say, ‘I don’t want to be
though. Early stage doesn’t Monitoring doesn’t mean Researchers wondered: to monitoring wound up impotent, I don’t want to
necessarily mean low risk. do nothing. Men can get Would the results be the getting some sort of treat- be incontinent,’” and will
Some results in the study frequent tests, and there same with modern screen- ment within five years. In forgo surgery even if there’s
lean in favor of surgery, and are more and better ways ing and treatments? one quarter of those cases, a chance it will help them
it does have some advan- to detect disease progres- The new study, sponsored men “just got fed up” with live longer, he said. “In the
tages. It also may improve sion now than there used by the U.S. Department of monitoring and thinking end, each man’s going to
survival for certain groups. to be, so there’s usually still Veterans Affairs, aimed to about cancer, Andriole make his own decision.”q