Steven E. Canfield, MD
In men with early prostate cancer, does radical prostatectomy reduce mortality and disease progression more than watchful waiting over the long term?
Randomized controlled trial (Scandinavian Prostate Cancer Group Study Number 4 [SPCG-4]).
{Concealed}*.†
Blinded (endpoint committee evaluating cause of death {and pathology review}‡).†
Median 12.8 years.
14 centers in Sweden, Finland, and Iceland.
698 men < 75 years of age (mean age 65 y) who had newly diagnosed, localized (stage T0d [later named T1b], T1 [later including T1c], or T2) prostate cancer with a moderately well- or well-differentiated tumor; prostate-specific antigen (PSA) level < 50 ng/mL; negative bone scan; no other cancers; and life expectancy > 10 years.
Radical prostatectomy (n = 349) or watchful waiting (n = 349).
All-cause mortality, prostate cancer mortality, distant metastases, and local progression.
> 99% (intention-to-treat analysis).
Radical prostatectomy reduced all-cause mortality, prostate cancer mortality, distant metastases, and local progression more than watchful waiting (Table). In subgroup analyses, the benefit of radical prostatectomy for all-cause mortality was greater in younger men (< 65 y, 15-y cumulative incidence 34% vs 47%; ≥ 65 y, cumulative incidence 56.7% vs 57.4%, P = 0.003 for interaction); the benefit for prostate cancer mortality did not differ by age group (< 65 y, cumulative incidence 16% vs 26%; ≥ 65 y, cumulative incidence 13% vs 16%, P = 0.16 for interaction).
In men with localized, early prostate cancer, radical prostatectomy reduced mortality, distant metastases, and local disease progression more than watchful waiting over the long term.
Radical prostatectomy (RP) vs watchful waiting (WW) in early prostate cancer§
§Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
||Estimated using Cox proportional-hazards models. Median follow-up was 12.8 y.
¶RRR and NNT are in the same direction; however, the CI for the NNT is wider and not significant.
Canfield SE. Radical prostatectomy reduced mortality and disease progression over the long term more than watchful waiting in early prostate cancer. Ann Intern Med. ;155:JC1–2. doi: 10.7326/0003-4819-155-2-201107190-02002
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© 2018
Published: Ann Intern Med. 2011;155(2):JC1-2.
DOI: 10.7326/0003-4819-155-2-201107190-02002
Hematology/Oncology, Prostate Cancer.
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