TITLE

2011 - Radical prostatectomy reduced mortality and disease progression over the long term more than watchful waiting in early prostate cancer

AUTHOR(S)
Canfield, Steven E.
PUB. DATE
July 2011
SOURCE
ACP Journal Club;7/19/2011, Vol. 155 Issue 1, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Question In men with early prostate cancer, does radical prostatectomy reduce mortality and disease progression more than watchful waiting over the long term? Methods Design Randomized controlled trial (Scandinavian Prostate Cancer Group Study Number 4 [SPCG-4]). Allocation {Concealed}*.† Blinding Blinded (endpoint committee evaluating cause of death {and pathology review}‡).† Follow-up period Median 12.8 years. Setting 14 centers in Sweden, Finland, and Iceland. Patients 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 é>10 years. Intervention Radical prostatectomy (n =>349) or watchful waiting (n =>349). Outcomes All-cause mortality, prostate cancer mortality, distant metastases, and local progression. Patient follow-up é>99% (intention-to-treat analysis). Main results 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). Conclusion 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.
ACCESSION #
65456981

 

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