"Among men under  with early stage prostate cancer those who have the prostate gland removed are less likely to die than those who adopt a watchful waiting approach according to a new longterm study out of Europe. But the findings are not likely to be practicechanging said Dr. Richard E. Greenberg chief of urologic oncology at Fox Chase Cancer Center in Philadelphia who was not involved with the study.  This is relatively early stage disease and it shows what we would expect it to show that those who have more years to live have better survival if treated aggressively he said.  Men with prostate cancer face a confusing maze of options today including not only surgery but hormone therapy different kinds of radiation therapy and even simply foregoing medical treatment while monitoring the cancer closely watchful waiting also known as active surveillance. Watchful waiting is often recommended when a man is not expected to die of the cancer and would like to avoid the risk of the debilitating side effects associated with prostate cancer treatment. These may include incontinence and erectile dysfunction surgery erectile dysfunction and secondary cancers radiation therapy nausea breast growth liver problems hormonal therapy and weakness hair loss fluid retention chemotherapy. The data presented in the May  issue of the New England Journal of Medicine is a year followup of a study for which threeyears of followup had previously been reported.  The earlier study also found that undergoing a radical prostatectomy lowered the risk of the cancer spreading as well as the death rate from prostate cancer or any other cause.  The researchers Drs. Anna BillAxelson and Lars Holmberg of University Hospital Uppsala and colleagues enrolled nearly  men with early prostate cancer under the age of  who were randomly selected either to undergo a radical prostatectomy or to stay in watchful waiting mode.  After an average followup of about  years . percent of the men who had undergone surgery had died versus . percent in the watchful waiting group a  percent reduced risk.  The benefit was primarily seen among men younger than  and the authors estimated that seven men under the age of  and  over the age of  would need to be treated to save one life.  There was also a benefit in men whose tumors had lowrisk characteristics.  Men whose cancer had moved outside of the prostate gland and who underwent removal of the prostate had a seven times higher risk of dying than men whose tumors hadnt spread.  Radical prostatectomy can come with a price  including erectile dysfunction urinary incontinence and even bowel incontinence  although these effects are not as common as techniques improve. A nervesparing radical prostatectomy for example may be able to prevent erectile dysfunction. Also the men in this study were diagnosed only after they had symptoms unlike the majority of men in the United States Greenberg said.  The advantage of screening is that men are more likely to be cured of cancer but they also have a greater chance of not succumbing to the consequences of the surgical complications whether those be erectile dysfunction or urinary incontinence Greenberg said.  Also he said erectile dysfunction can also be a factor of aging and can be treated in most cases.  But much remains to be known about how best to treat different types of prostate cancer.  The management of early stage prostate cancer continues to require further randomized controlled studies which are underway to determine the true benefit of treatment versus expectant management said Dr. Marc Danziger an attending urologist at Lenox Hill Hospital in New York City who was not involved with the study.  Currently the potential benefit and side effects of treatment needs to be addressed on an individual basis in relation to the risk stratification of disease patient desires health status and risk tolerance Danziger added. More information  The U.S. National Cancer Institute has more on prostate cancer treatments http SOURCES Richard E. Greenberg M.D. chief urologic oncology Fox Chase Cancer Center Philadelphia Marc D. Danziger M.D. attending urologist Lenox Hill Hospital New York City May   New England Journal of Medicine"