At first, finding prostate cancer early with the PSA test or a digital rectal exam, and undergoing a radical prostatectomy seems like a good idea. Then, you start to research the data behind early diagnosis and radical surgery, and, sooner or later, undergoing surgery seems like a very bad idea.

It all depends on what kind of researcher you are. Do you believe in facts and randomized controlled studies? Or, are you easily swayed by what urologists say, reporters report, or what men who are still struggling with recovering from their sacrifice of having undergone surgery have to say?

The coin has been flipped 806 times now, meaning that 806 men have been studied in randomized controlled trials to determine the efficacy of the radical prostatectomy for localized prostate cancer. In one study 111 men were studied for 23 years. There was no increase in survival for those undergoing surgery even after 23 years. In another study, 695 men were studied for 6.2 years. Again, there was no increase in survival. In the words of the authors of the second study, " . . . there was no significant difference between surgery and watchful waiting in terms of overall survival."

Sources for the Prostate Cancer Randomized Controlled Studies:
1) Iversen P, Madsen P, and Corle D: Radical Prostatectomy Versus Expectant Treatment for Early Carcinoma of the Prostate. Twenty-three Year Follow-up of a Prospective Randomized Study. Scandinavian Journal of Urology and Nephrology. January 1, 1995;Supplement 172:65-72.

2) Holmberg L, Bill-Axelson A, Helgesen F, Salo JO, Folmerz P, Haggman M, Andersson SO, Spangberg A, Busch C, Nordling S, Palmgren J, Adami HO, Johansson JE, Norlen BJ; Scandinavian Prostatic Cancer Group Study Number 4. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. New England Journal of Medicine. 2002:Sep 12;347(11):781-789.

Written by Bradley Hennenfent, MD, July 18, 2004 for SurvivingProstateCancerWithoutSurgery.org

Update:

Five years after the Holmberg study above, it's follow up came out. And in that follow-up study 95% of men failed to have any increase in survival, even after 10 years of suffering from the side effects of surgery. That's a 95% percent failure rate for the radical prostatectomy after 10 years of waiting for a benefit. These are not good numbers.

Source: Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005 May 12;352(19):1977-84.Bill-Axelson A, Holmberg L, Ruutu M, Häggman M, Andersson SO, Bratell S, Spångberg A, Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlén BJ, Johansson JE; Scandinavian Prostate Cancer Group Study No. 4.

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