Researchers are always comparing one to the other to find the best for each patient.
Prostate cancer options include radiation, a surgery called radical prostatectomy which removes the cancer, and watchful waiting, which keeps an eye on the cancer over time.
The New England Journal of Medicine compared death rates in Scandinavian men for two of the options.
These two men represent the two treatments for prostate cancer in the study. Virgil Simons opted for surgery rather than radiation seventeen years ago.
"Getting it out through surgery had a greater degree of certainty," said Simons, a now prostate cancer survivor,
Alan Hiller, 73, was concerned about the side effects of surgery or radiation. He decided on watchful waiting, also called active surveillance, just testing to watch the cancer.
"You are actively involved in tracking the disease with a PSA through biopsies," said Hiller
Two men with two approaches: surgery versus watchful waiting.
The study found that for men under age 65, surgery had fewer deaths over the 12 year follow-up of the study. The Scandinavian men had more advanced cancer than most American men.
The study looked at men who had growths on their prostates that could be felt on a rectal exam.
Most men in the U.S. have cancers found at an earlier stage through a prostate-specific antigen (PSA) test.
Because PSA testing can find earlier cancers, the study results don't apply to most men in the U.S. They apply to men with more advanced cancers found on rectal exam.
"No matter how old you are, if you have a nodule on your prostate gland found by digital rectal exam, you should be treated for your prostate cancer, not just watched," said Ihor Sawczuk, from Hackensack University Medical Center.
The study found no difference in deaths for men over 65.
The message is that younger men with prostate nodules do better with surgery. With early cancers found by PSA tests, all three options are viable. And each man will be different.
The treatments should be individualized based on discussions with doctors about a man's age, other medical problems, and the aggressiveness of the cancer, among other things.
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