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Jim Hu, M.D. The survival rate for early-stage prostate cancer is 99 percent after 10 years, regardless of whether men undergo surgery, radiation or are “actively monitored,” according to two new studies from the universities of Oxford and Bristol published in the New England Journal of Medicine. They found no difference in survival rates among men who were randomly assigned to surgery, radiation or monitoring; it is the largest study of its kind. Those who underwent surgery or radiation cut in half the risk that their disease would spread to bones and lymph nodes, compared with those who were simply monitored. Although the treatment didn’t extend life during the first 10 years, a survival benefit might yet emerge in the next five or 10 years, the researchers said.

The scientists also found that the surgery and radiation treatments sometimes caused severe side effects, including sexual dysfunction, incontinence and bowel problems, that hurt the patients’ quality of life, illustrating the complicated treatment equations facing men with early-stage prostate cancer, and setting off a debate among physicians about how to interpret the results.

Among those who commented in the press was Jim Hu, M.D., Director of the LeFrak Center for Robotic Surgery and the Ronald P. Lynch Professor of Urologic Oncology. 

He told The Washington Post he was struck by the “significant differences in the likelihood of metastatic disease,” which he said could eventually translate into a survival benefit for the men who got surgery or radiation.

Learning more about who developed metastatic disease will be the key to advising men about active surveillance, he told MedPage Today. Noting that the men enrolled in the study had low-risk cancer (Gleason score 6, PSA <10 ng/mL), Hu said, "For men I see with low-risk disease, I always offer active monitoring, or active surveillance."

"So why was there a statistical difference in metastases and disease progression?" Hu continued. "Presumably, this is driven by the men who do not have low-risk cancers -- they have significant prostate cancers."

For men with truly low-risk disease, "monitoring at 10 years is not going to increase your risk of death from prostate cancer. What we need to clarify is who will develop metastases and disease progression," said Hu.