Radical prostatectomy versus observation for localized prostate cancer

Timothy J Wilt ¹, Michael K Brawer , Karen M Jones

⁰Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs (VA) Health Care System, and Section of General Medicine, University of Minnesota School of Medicine, Minneapolis, USA. tim.wilt@va.gov

The New England Journal of Medicine +

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July 20, 2012

View abstract on PubMed

Summary

Radical prostatectomy did not significantly lower mortality for localized prostate cancer compared to observation. Long-term follow-up showed minimal absolute differences in outcomes for men diagnosed via PSA testing.

Area Of Science

Urology
Oncology
Clinical Trials

Background

Effectiveness of surgery versus observation for localized prostate cancer is unknown.
Prostate cancer often detected via prostate-specific antigen (PSA) testing.

Purpose Of The Study

To compare radical prostatectomy versus observation for localized prostate cancer.
To assess impact on all-cause and prostate-cancer mortality.

Main Methods

Randomized trial of 731 men with localized prostate cancer (mean age 67).
Assignment to radical prostatectomy or observation.
Follow-up through January 2010 (median 10.0 years).

Main Results

No significant difference in all-cause mortality (47.0% vs 49.9%).
No significant difference in prostate-cancer mortality (5.8% vs 8.4%).
Radical prostatectomy showed potential benefit for PSA > 10 ng/mL or high-risk tumors.

Conclusions

Radical prostatectomy did not significantly reduce mortality for localized prostate cancer versus observation.
Absolute mortality differences were less than 3 percentage points.
Findings apply to men diagnosed in the early PSA testing era.

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