Radical prostatectomy versus watchful waiting in early prostate cancer

January 01, 0001

Radical prostatectomy versus watchful waiting in early prostate cancer

These Swedish authors reported in 2008 that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, they now report estimated 15-year results. From October 1989 through February 1999, they randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy.

They found: "During a median of 12.8 years, 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died. In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting, death was due to prostate cancer. This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6% and 20.7%, respectively, and a relative risk with surgery of 0.62. The survival benefit was similar before and after 9 years of follow-up, was observed also among men with low-risk prostate cancer, and was confined to men younger than 65 years of age. The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age. Among men who underwent radical prostatectomy, those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth."

The authors concluded: "Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment."

Since treatment made a difference these data suggest that screening men under 65 for prostate cancer may be beneficial.

For the full abstract, click here.

N Engl J Med 364:1708-1717, 5 May 2011
© 2011 to the Massachusetts Medical Society
Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer. Anna Bill-Axelson, Lars Holmberg, Mirja Ruutu, et al. Correspondence to Dr. Bill-Axelson: [email protected]

Category: Y. Male Genital System, Breast. Keywords: prostate cancer, prostatectomy, watchful waiting, survival, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 17 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.