Jeremy Laurance: Now fight must focus on men with aggressive tumours

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Surgeons love to operate. It takes guts to slice someone open and to accomplish it you have to be convinced of the value of what you are doing.

That is why the results of the Pivot trial of surgery for prostate cancer, the largest of its kind in the world, were met with silence when they were presented in Paris. It was not what the urologists in the audience wanted to hear. It will not be what patients awaiting surgery will want to hear either. The message of the research is that efforts must now be redoubled to identify and treat men with high risk cancers who will benefit from treatment. In up to half of men the cancer is so slow growing they are likely to die of something else. Advances have been made in the detection and treatment of prostate cancer since the trial began over 15 years ago. Using MRI scans and other techniques, specialists are better at categorising men as high or low risk.

Britain's NHS is also better than the profit driven health system in the US at advising men when surgery is not the right option and it is better to wait and watch. This approach has one great advantage over surgery – there are no side effects.

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