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Radical prostatectomy versus observation for localized prostate cancer
Timothy J Wilt1, Michael K Brawer, Karen M Jones
1Center 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
|July 20, 2012
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.
