"For men diagnosed with prostate cancer uncertainty about what to do remains a big problem despite years of research on the options. Now a Swedish study http suggests that radical prostatectomy  complete removal of the prostate gland  is better than watchful waiting for the treatment of younger men with lowrisk prostate cancer. On the surface this seems to contradict a U.S. trend toward holding off on surgery and monitoring men who have lowrisk cancers with whats called active surveillance http But dont leap to any conclusions. Like every new study of prostate cancer the results need to be carefully parsed. First the study results http which appear in this weeks New England Journal of Medicine. Its actually an update of a  report with an additional three years of data on the nearly  men who volunteered for the trial up to  years ago. All of them had earlystage prostate cancer at the beginning. The study found  percent fewer prostate cancer deaths among men randomly assigned to the surgery group versus those in what the Swedes called the watchfulwaiting group. Men who had surgery had  percent lower risk of their cancer spreading throughout the body and  percent less risk of growth within the prostate. Article continues after this message from our sponsor The survival benefits were restricted to men under . For this group surgery saved one life for every seven men who had prostatectomies  considered a favorable ratio http And it applied to men with tumors considered lowrisk meaning they have a relatively low Gleason score http a marker of tumor aggressiveness. Our findings show that some tumors that are considered to be lowrisk at diagnosis do pose a threat to life especially if they are not surgically removed the study authors write. So is this a slamdunk for radical prostatectomy Game over Far from it. In an editorial http accompanying the study Dr. Dr. Matthew Smith http of Massachusetts General Hospital makes some important points. First only about  in  men in the Swedish study had a prostate cancer diagnosis based on a high PSA level http Almost  percent had tumors their doctors could feel on digital rectal exams. But in the U.S. most prostate cancers are identified by PSA screening and less than half have palpable tumors. This is important because experts believe many prostate tumors found by PSA are likely to be slowgrowing  perhaps so slow they will never cause a problem before the man dies of something else. So low risk in the Swedish study means higherrisk than the current low risk men diagnosed in the United States. By the way  out of  prostate cancers in the U.S. these days is considered low risk. Second the Swedish study compared radical prostatectomy to watchful waiting. And Smith points out that watchful waiting does not mean the same thing as active surveillance. Watchful waiting means were not going to treat you now and if you progress clinically well treat you with hormone therapy  not with curative intent Smith tells Shots. Active surveillance means observing the patient in a proactive way with regularly scheduled biopsies he adds. If theres a sign the cancer is progressing doctors currently would treat with intent to cure using surgery radiation or both. Smith makes another point Both surgical techniques and radiation therapy technology have improved since the Swedish study was done. So theres reason to think men followed with active surveillance and treated when necessary would fare better than the watchful waiting group in the newly published study. Unfortunately there havent been any large studies in which prostatectomy and radiation therapy have been compared in patients with earlystage prostate cancer who have been randomly assigned to one or the other. Two such studies are underway. Results are some years off. But Smith warns against assuming those results will settle the question of how men with earlystage prostate cancer should be treated. There will always be questions and an ongoing need to individualize therapy he says."