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Updated: Feb 26, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.
Timothy J Wilt1, Karen M Jones1, Michael J Barry1
1From the Minneapolis Veterans Affairs (VA) Health Care System and Center for Chronic Disease Outcomes Research and the Section of General Medicine, University of Minnesota School of Medicine, Minneapolis (T.J.W.); the VA Cooperative Studies Program Coordinating Center, Perry Point, MD (K.M.J.); the General Medicine Division, Massachusetts General Hospital, Boston (M.J.B.); the Division of Urology, Washington University School of Medicine, St. Louis (G.L.A.); the Department of Urology, University of Oklahoma College of Medicine, Oklahoma City (D.C.); the Department of Pathology and Immunology, Baylor College of Medicine, Houston (T.W.); VA Medical Center, Greater Los Angeles Healthcare System, Los Angeles (W.J.A.); and Myriad Genetics Laboratories, Salt Lake City (M.K.B.).
For localized prostate cancer, radical prostatectomy surgery did not significantly reduce all-cause or prostate cancer mortality compared to observation over nearly 20 years. Surgery led to more adverse events but less treatment for disease progression.
Area of Science:
- Urology
- Oncology
- Clinical Trials
Background:
- Previous studies showed no significant mortality differences between localized prostate cancer surgery and observation.
- Uncertainty remains regarding long-term nonfatal health outcomes and mortality.
- The PIVOT trial aimed to clarify these long-term outcomes.
Purpose of the Study:
- To compare all-cause mortality and prostate cancer mortality between radical prostatectomy and observation in men with localized prostate cancer.
- To evaluate disease progression, treatment patterns, and patient-reported outcomes.
- To assess long-term survival and adverse events associated with each treatment approach.
Main Methods:
- A randomized controlled trial involving 731 men with localized prostate cancer.
- Participants were assigned to either radical prostatectomy or observation.
- Extended follow-up was conducted through August 2014 for mortality outcomes.
Main Results:
- After a median follow-up of 12.7 years (19.5 years maximum), no significant difference in all-cause mortality (61.3% vs. 66.8%) or prostate cancer mortality (7.4% vs. 11.4%) was observed between surgery and observation groups.
- Surgery was associated with a lower frequency of treatment for disease progression (26.2 percentage points difference).
- Adverse events, including urinary incontinence and erectile dysfunction, were more frequent after surgery, persisting for up to 10 years.
Conclusions:
- Radical prostatectomy for localized prostate cancer did not demonstrate a significant survival benefit compared to observation after nearly two decades.
- Surgery was linked to increased adverse events but reduced the need for subsequent disease progression treatments.
- The findings suggest a need to carefully weigh the risks and benefits of surgery versus observation for localized prostate cancer.
