Case in point: the recent assessment of prostate cancer surgery printed in The New England Journal of Medicine.

A Swedish study of men 60-70 years old found the surgery did cut prostate cancer deaths, but it didn't find any change in the overall death rate for men of that age who participated in the study.

"It's a very interesting and somewhat exciting study," says Dr. Durado Brooks, director of prostate cancer for the American Cancer Society's national office.

"For the first time, there is evidence surgery does make a difference in terms of prostate cancer. But it's tempered by the finding that there was no difference in the overall survival. Deaths were lower from prostate cancer but not lower overall. You might die from something else."

Immortality is not an option, but if you're going to die anyway, maybe there is a better choice than prostate cancer. The problem, of course, is that we can't usually pick what disease or illness ends our lives.

"Your chance of dying, on the whole, was not impacted," Brooks said, And, he added, "radiation (treatment) was not addressed at all."

So there might still be a viable option radiation besides surgery to treat prostate tumors.

"There is some evidence that suggests that radiation may be as efficacious (as surgery,)" he said.

All of this is a lot for men to grasp and make sense of.

"I think that science tends to do that, confuse everybody," Brooks acknowledged. "Every positive finding, it's important to spell out the things we don't know."

What we do know is, as he put it, "dying from prostate cancer is a very unpleasant death."

We also know that prostate surgery can cause impotence and incontinence, a very unpleasant lifestyle.

And there is another wrinkle.

The tumors of the men in the Swedish study weren't detected through PSA screening, a controversial blood test used to find prostate cancer before there are any symptoms.

These men had detectable tumors without a blood test.

So?

"This study does not clarify the PSA issue," Brooks said.

"There is still debate about the utility of screening. The ACS says inform men by (age) 50 about pros and cons of the screening and potential negative impacts.

"For high-risk men, those who have prostate in the family and African-Americans, they should begin annual testing at 45. They felt the evidence was clear and would save lives."

But on the issue of treatment, Brooks says we still need more studies of radiation, and of the use of PSA screening, too.

Such studies are under way here and in Europe, but probably won't produce results for three to five years.

Meanwhile, the picture is clearer particularly for older men with identifiable tumors but still not completely in focus.

Cox News Service