Exclusive

Study raises doubts over treatment for prostate cancer

Experts shaken by verdict suggesting thousands of men go through painful treatment for nothing

Cancer specialists are bracing themselves for publication of a research study that will challenge the way one of the commonest cancers is treated. The world's biggest randomised trial of prostate cancer has found that the standard surgical treatment for the disease is ineffective.

Click HERE to view 'Statistics on prostate cancer' graphic

The study compared surgical removal of the prostate gland – radical prostatectomy – with "watchful waiting" (doing nothing). The results show that surgery did not extend life. A leading British specialist, who asked not to be named, said: "The only rational response to these results is, when presented with a patient with prostate cancer, to do nothing."

Cancer of the prostate is the commonest male cancer affecting 37,000 men a year in the UK and causing 10,000 deaths.

But in up to 50 per cent of cases it is slow-growing so that patients affected, even when left untreated, can live for many years and die of something else.

Some specialists are beginning to question whether these cases qualify for the label "cancer" at all.

The results of the Prostate Intervention Versus Observation Trial (PIVOT), led by Timothy Wilt and started in 1994 with 731 men, showed that those who underwent the operation had less than a three per cent survival benefit compared with those who had no treatment, after being followed up for 12 years. The difference was not statistically significant and could have arisen by chance.

When the findings were presented at a meeting of the European Association of Urology in Paris in February, attended by 11,000 specialists from around the world, they were greeted with a stunned silence.

One expert who attended the meeting said that while most research results are immediately transmitted by specialists in the audience using social media, "I did not see any urologists enthusiastically tweeting about [this one]."

Prostate cancers are already classified as "tigers" (aggressive) or "pussy cats" (low risk). But some urologists who have spent years training to perform complex surgical techniques find the idea of watchful waiting unacceptable.

Surgery carries a risk of side effects that can have a serious impact on quality of life with 50 per cent of men suffering impotence and 10 per cent incontinence.

Ben Challacombe, consultant urologist at Guys and St Thomas' NHS Trust, disagreed with the analysis that the response should be to do nothing. Many of the men in the trial were older, with an average age of 67, low risk and would not have been offered surgery in the UK.

"We would offer milder treatment such as radiotherapy or watchful waiting. We are better than the US in putting men on surveillance," he said.

The controversy over the best treatment for prostate cancer has split professional opinion. Some specialists claim treatment is at the stage where breast cancer was a generation ago when the only surgical treatment was mastectomy, removal of the whole breast.

Today most women with breast cancer are treated with lumpectomy, involving surgical removal of the tumour, leaving the rest of the breast intact. Urologists believe a similar approach in prostate cancer could improve survival and reduce the risk of side effects because a smaller proportion of the prostate gland would be targeted and surrounding tissue left unaffected.

Critics of the approach say there is not enough evidence to justify targeted therapy. Joel Nelson, of the department of urology at the University of Pittsburgh, said prostate cancer triggers molecular changes in the whole of the gland, which can lead to "malignant transformation".

Targeting only part of the gland gives a "false sense of security", when there is a risk of recurrence which could be harder to treat, Mr Nelson said. There are no clear criteria of success which could lead to "technical incompetence".

Dr Kate Holmes, head of research at The Prostate Cancer Charity, said: "Early data from the PIVOT trial certainly suggests that surgery to remove the prostate does not provide any significant survival benefit for men with low to medium risk prostate cancer. However, these findings are from a large ongoing trial, and we look forward to seeing the full published results which could help men in future to make more informed decisions about treatment. "

Facts

37,000 The number of British men newly diagnosed with prostate cancer every year

50% The rise in the number of men diagnosed with the condition in the last 20 years

10,000 The number of British men who die from prostate cancer each year

70% The proportion of men with prostate cancer who survive for at least five years

1 in 4 Prostate cancer is often considered an older man's problem, but 25 per cent of cases are in those under 65

Suggested Topics
News
John Travolta is a qualified airline captain and employed the pilot with his company, Alto
people'That was the lowest I’d ever felt'
Life and Style
healthIt isn’t greasy. It doesn’t smell. And moreover, it costs nothing
Sport
Jonas Gutierrez (r) competes with Yaya Toure (l)
football

Newcastle winger is in Argentina having chemotherapy

Arts and Entertainment
Emma Thompson and Bryn Terfel are bringing Sweeney Todd: The Demon Barber of Fleet Street to the London Coliseum
theatre

Returning to the stage after 20 years makes actress feel 'nauseous'

PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
News
peopleThe Times of India said actress should treat it as a 'compliment'
News
news

Watch this commuter wage a one-man war against the Circle Line
Property
Home body: Badger stays safe indoors
lifeShould we feel guilty about keeping cats inside?
News
A male driver reverses his Vauxhall Astra from a tow truck
news

Man's attempt to avoid being impounded heavily criticised

Arts and Entertainment
Blossoming love: Colin Firth as Stanley and Emma Stone as Sophie, in 'Magic in the Moonlight'
film

Colin Firth and Emma Stone star together in Magic in the Moonlight: Woody Allen's 1920s romance

Arts and Entertainment
You've been framed: Henri Matisse's colourful cut-outs at Tate Modern
artBut what makes a smash-hit art show?
Arts and Entertainment
US pop diva Jennifer Lopez sang “Happy Birthday” to Gurbanguly Berdimuhamedow, president of Turkmenistan
musicCorporate gigs become key source of musicians' income
Arts and Entertainment
While many films were released, few managed to match the success of James Bond blockbuster 'Skyfall'
filmsDaniel Craig believed to be donning skis as 007 for first time
Student
The Guildhall School of Music and Drama is to offer a BA degree in Performance and Creative Enterprise
student

Sport
Mikel Arteta pictured during Borussia Dortmund vs Arsenal
champions league
Voices
Yes supporters gather outside the Usher Hall, which is hosting a Night for Scotland in Edinburgh
voicesBen Judah: Is there a third option for England and Scotland that keeps everyone happy?
Arts and Entertainment
Pulp-fiction lover: Jarvis Cocker
booksJarvis Cocker on Richard Brautigan
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    March On Cancer™ - Local Marketing and Promotions Volunteer

    This is an unpaid voluntary role.: Cancer Research UK: We need motivational vo...

    SEN Coordinator + Teacher

    £1 per day: Randstad Education Leeds: Job Purpose To work closely with the he...

    Maths Teacher - Evening session

    Negotiable: Randstad Education Birmingham: I am looking for a qualified experi...

    Teaching Assistants

    £50 - £85 per day: Randstad Education Preston: Rapidly developing and growing ...

    Day In a Page

    Mystery of the Ground Zero wedding photo

    A shot in the dark

    Mystery of the wedding photo from Ground Zero
    His life, the universe and everything

    His life, the universe and everything

    New biography sheds light on comic genius of Douglas Adams
    Save us from small screen superheroes

    Save us from small screen superheroes

    Shows like Agents of S.H.I.E.L.D are little more than marketing tools
    Reach for the skies

    Reach for the skies

    From pools to football pitches, rooftop living is looking up
    These are the 12 best hotel spas in the UK

    12 best hotel spas in the UK

    Some hotels go all out on facilities; others stand out for the sheer quality of treatments
    These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

    Widespread fear of Isis is producing strange bedfellows

    Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
    Topshop goes part Athena poster, part last spring Prada

    Topshop goes part Athena poster, part last spring Prada

    Shoppers don't come to Topshop for the unique
    How to make a Lego masterpiece

    How to make a Lego masterpiece

    Toy breaks out of the nursery and heads for the gallery
    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
    Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

    Ian Paisley’s decision to make peace with his IRA enemies

    His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    Exclusive extract from Janis Winehouse's poignant new memoir
    Is this the role to win Cumberbatch an Oscar?

    Is this the role to win Cumberbatch an Oscar?

    The Imitation Game, film review
    England and Roy Hodgson take a joint step towards redemption in Basel

    England and Hodgson take a joint step towards redemption

    Welbeck double puts England on the road to Euro 2016
    Relatives fight over Vivian Maier’s rare photos

    Relatives fight over Vivian Maier’s rare photos

    Pictures removed from public view as courts decide ownership
    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    Donatella Versace at New York Fashion Week