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Surgery not necessarily the best option for prostate cancer

Blood sample positive with PSA (prostate specific antigen)

More evidence that surgery may not be the best option for men with early-stage prostate cancer was published recently in the New England Journal of Medicine.  Prostate Cancer Intervention Versus Observation Trial (PIVOT), a study of men with tumors confined to the prostate gland, is an important 20-year study lead by the Minneapolis Veterans Affairs Health Care System.

PIVOT Study finds no differences in mortality

“Researchers randomly assigned 731 men, average age 67, with localized prostate cancer to receive either surgery or observation only. At the 20-year follow-up, 62% of the men who had prostate cancer surgery had died of other causes, while only 7% died from prostate cancer. In comparison, 67% of the men assigned to observation died from other causes and 11% from prostate cancer. The absolute differences in mortality were not significant,” according to Harvard Health Publishing.

Quality of life often suffers after prostate surgery

Following both groups of men into their mid-80’s, the study also yielded important outcomes information.   “Most striking was how often erectile dysfunction and urinary incontinence occurred following surgery. For instance, 80% of the surgery group reported having erectile dysfunction throughout the study, compared with 40% of the men who were not treated. And more than 40% of the men who’d had surgery needed to use a daily pad to manage the urinary incontinence, compared with less than 10% of the observation group.”

Observation through Active Surveillance

Focusing on quality of life, Chicago Prostate Cancer Center (CPCC) tailors treatment to maximize each patient’s health outcomes. At the Center, men who choose to follow the observation path, also called Active Surveillance, receive periodic evaluation for prostate cancer risk based on: prostate specific antigen (PSA) blood test results, detection of abnormal prostate upon digital rectal exam, current and past health considerations, family history of prostate or other cancers, as well as other factors.

Valuable information available with sophisticated mapping biopsy

Men benefiting from CPCC’s Active Surveillance protocol may be candidates for Stereotactic Transperineal Biopsy (STPB).  A sophisticated mapping technique pioneered by the Center, STPB provides a comprehensive understanding of the entire prostate gland, even areas “hidden” to the approach taken with more limited, routine rectal biopsies.

Tissue sampling by STPB opens the door to information such as tumor grading and prostate cancer staging. Furthermore, genomic analysis of tissue samples can reveal how aggressively a tumor is likely to grow, helping gauge the need for more active treatment.  STPB, performed with the aid of high resolution ultrasound, also adds mapping data about relative tumor location within the prostate gland, informing treatment planning if needed in the future.

Seed implant as happy medium between observation and surgery

Taken together, this information helps men undergoing observation for prostate cancer decide with their physician whether or when definitive treatment becomes their next step.   And if so, men are advised to explore all their treatment options, including alternatives to prostate removal surgery.  According to Dr. Brian J. Moran, CPCC Medical Director, “Prostate seed implant can be a happy medium between observation and surgery.” Especially for cancers located within the prostate gland, seed implant (or low-dose rate brachytherapy) provides an effective, minimally invasive treatment, with better urinary, rectal and sexual functioning outcomes, and a quicker return to normal daily activities and life-style.

Contact  Chicago Prostate Cancer Center

For more information, or to schedule a consultation, contact the Chicago Prostate Cancer Center at 630-654-2515, or visit

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