Prostate surgery best choice for men under 65

A landmark study of one the most agonizing decisions faced by men with early prostate cancer--Should I have surgery? Or should I wait and see if it spreads?--found that for those under 65, operating clearly saves lives, cutting the death rate by more than half. For men over 65, however, the jury is still out. These men account for the vast majority of prostate cancer patients. Because of the findings, younger men "are much less likely to be encouraged to watch and wait," said Durado Brooks, director of prostate cancer at the American Cancer Society. Prostate cancer is the second-most common type of cancer in American men, after skin cancer. About 232,000 new cases and 30,000 deaths are expected this year in the United States, according to the Cancer Society. Often doctors recommend "watchful waiting" because in many men the tumor grows so slowly that they die of something else before the cancer ever kills them. Also, surgery to remove the diseased prostate carries its own risks: impotence and incontinence. The latest study, published in Thursday's New England Journal of Medicine, followed Scandinavian men under age 75 for a decade after surgery, an unusually long period for such research. Overall, it found that surgery reduces deaths from any cause--not just cancer of the prostate--by nearly half. About 9.5% of those who got surgery and 15% of those in the watchful waiting group died within 10 years of being diagnosed. But all the benefit appeared to be among men under 65, where the watchful waiting group had more than double the death rate of the surgery group. Among all men in the study, after 10 years those getting surgery had a 44% lower rate of death from prostate cancer, a 26% lower rate of death from all causes, and sharply lower rates of cancer spread. The lead author of the study, Anna Bill-Axelson of University Hospital in Uppsala, Sweden, said urologists who favor surgery over watchful waiting will now be able to say that in younger men, "there is finally proof it saves lives." Prostate cancer strikes one in six American men during their lifetime, killing one in 33. About 60,000 Americans undergo prostate cancer surgery each year. A man's age, his overall health, how advanced the cancer is, and how aggressive it appears under the microscope are among the factors doctors use in deciding whether to recommend surgery. (AP)