Surgery may beat radiation for men with early stage prostate cancer

By Helen Ndukwe

Men with prostate cancer that’s still confined to the organ are more likely to survive if they have surgery rather than radiation therapy, a new Canadian study suggests.
This type of “localized” prostate cancer is the most common form of the disease, accounting for about 80 percent of cases, said a team led by Dr. Robert Nam of the Odette Cancer Centre at Sunnybrook Research Institute in Toronto.
The most common treatments for localized prostate cancer are surgery and radiation therapy.
But which works best to keep the disease at bay?
To find out, Nam’s team looked over data from 19 studies that included a total of nearly 119,000 men with localized prostate cancer.
Findings from 15 of the studies showed that those who received radiation therapy were twice as likely to die from prostate cancer as those who had surgery.
Findings from 10 of the studies also showed that men who had radiation therapy were 50 percent more likely to die sooner of any cause, compared to those who had surgery.
The results of the analysis were published Dec. 14 in the journal European Urology.
“In the past, studies that have compared the success rates of surgery or radiation have been confusing because of their methods,” Nam said in a journal news release. “We have evaluated all the good-quality data comparing surgery and radiotherapy, and the results are pretty conclusive; in general, surgery results in better mortality rates than radiotherapy.”
But prostate cancer treatment is never a one-size-fits-all matter, he added.
“There are times when radiotherapy may be more appropriate than surgery, so it is important that a patient discusses treatment options with his clinician,” Nam said.
He believes that “the important thing about this research is that it gives physicians and patients additional information to consider when making the decision about how to treat localized prostate cancer.”
Two U.S. experts came to somewhat different conclusions about the results.
“The results of this study point not only to the efficacy of surgery as a principal mode of treatment and first line of defense against prostate cancer, but also as a way to extend the life of men affected by prostate cancer,” said Dr. David Samadi, chief of robotic surgery at Lenox Hill Hospital in New York City.
He said that surgical removal of the prostate “is the only option which removes the entire prostate, and therefore allows for more accurate staging and grading [of the tumor]. This means your doctor can create a better long-term plan of care for each individual patient.”
And Samadi stressed that “radiation is still possible as a secondary treatment after surgery. So patients have yet another way of combating their cancer if necessary.”
But another expert had some reservations about the study. Dr. Jonathan Haas is chief of radiation oncology at Winthrop-University Hospital in Mineola, N.Y. He said that the Canadian review may not have accounted for recent improvements in radiation treatment that could boost outcomes for patients.
According to Haas, what’s needed to answer the surgery-versus-radiation question is a “prospective randomized trial using state-of-the-art medicine.”
“Only then can the best conclusion be made,” he said. “Patients with this disease have many options including radiation, surgery, and possibly even surveillance. Only by individualizing a treatment plan for an individual patient with their specific information can the best outcomes be obtained.”
— Robert Preidt
Does Testosterone Give Men Better Direction Sense?
Dec. 8, 2015 — Men may have a better sense of direction than women because of their hormones, Norwegian scientists say.
They came to their conclusion by giving men and women route-mapping tasks, and then seeing if a small dose of testosterone “helped” the women’s performances.
In a lab, the participants donned 3-D goggles and steered with a joystick to complete tasks that involved finding their way between two points on a virtual maze. And they were up against the clock.
The researchers viewed the men and women’s brains with a real-time MRI scanner during the exercise.
Different Navigation Strategies
In the first tests involving 18 men and 18 women, “men’s sense of direction was more effective,” says Carl Pintzka, from the Norwegian University of Science and Technology. “They quite simply got to their destination faster.”
Although men solved 50% more of the tasks than the women, different tactics for navigating emerged.
Men used the points of the compass more than women did, Pintzka says. “If they’re going to the Student Society building in Trondheim, for example, men usually go in the general direction where it’s located. Women usually orient themselves along a route to get there, for example, ‘Go past the hairdresser and then up the street and turn right after the store.'”
Overall, using the main compass points is more efficient because it’s more flexible, he says. This strategy is less dependent on where you set off from.
The real-time MRI images showed some differences in areas of the brain used by men and women while navigating.
The guys were more likely to use the part called the hippocampus, while women used frontal areas of the brain more.
“That’s in sync with the fact that the hippocampus is necessary to make use of cardinal directions” using north, south, east, and west, Pintzka says.
He says evolution has played a role in the gender differences: “In ancient times, men were hunters and women were gatherers. Therefore, our brains probably evolved differently. For instance, other researchers have documented that women are better at finding objects locally than men. In simple terms, women are faster at finding things in the house, and men are faster at finding the house.”
Testosterone Test
In a second series of tests, some women were given a small dose (0.5 mg) of testosterone dissolved under their tongue. The researchers found that several members of this group were able to orient themselves better in the four main north, south, east, and west directions.
A group of 42 women was then divided in two, and the groups were randomly given the hormone or a placebo (fake) treatment. Neither the women nor the researchers knew who got which doses.
“We hoped that they would be able to solve more tasks, but they didn’t. But they had improved knowledge of the layout of the maze. And they used the hippocampus to a greater extent, which tends to be used more by men for navigating,” Pintzka says.
He says the findings may help us understand some symptoms of Alzheimer’s disease, where losing the sense of direction can be an early sign.
“Almost all brain-related diseases are different in men and women, either in the number of affected individuals or in severity. Therefore, something is likely protecting or harming people of one sex. Since we know that twice as many women as men are diagnosed with Alzheimer’s disease, there might be something related to sex hormones that is harmful,” he says.
The researchers say fluctuating female hormones during the women’s menstrual cycles may have affected the results. Some women may think having the navigation tests designed by a man may have played a role.

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