Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer

By A. Bill-Axelson, L. Holmberg, Hans Garmo, J. Rider, K. Taari, C. Busch, S. Nordling, M. Häggman, S. Andersson, A. Spångberg and 5 more. New England Journal of Medicine, 2014

907 citations recorded by the source corpus.

BACKGROUND Radical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. METHODS Between 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. RESULTS During 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P = 0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical pros-tatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P = 0.04). CONCLUSIONS Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.)

Subfields: Pulmonary and Respiratory Medicine, Urology

View Paper: https://www.semanticscholar.org/paper/0cd92ae89a564c9284f547a8d7f35744d4f0d017

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In Pulmonary and Respiratory Medicine

Citations in the corpus

Genetics and biology of prostate cancer (2018, background): “…managed by active surveillance, as large randomized clinical trials show no mortality differences between active surveillance and radical prostatectomy or radiotherapy (Iversen et al. 1995; Wilt et al. 2012; Bill-Axelson et al. 2014; Hamdy et al. 2016; Sanyal et al. 2016; Wilt et al. 2017).”
EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. (2017, methodology): “Data from SPCG-4 [53] and a preplanned subgroup analysis (PIVOT) [36] highlight the benefit of RP compared to WW.”
EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. (2024, neutral): “It is the only treat-ment for localised PCa to show a beneﬁt for OS and CSS, compared with WW in an RCT [79].”
A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score (2015, background): “Analyzing some of the highest impact recent articles on PCa reveals considerable diversity of Gleason score groupings: 2–4, 5–7, 8–10 (Prostate Cancer Outcomes Study) [7]; 2–6, 7, 8–10 (Scandinavian Prostate Cancer Group Study); and 2–6, 7–10 (Prostate Cancer Prevention Trial and Prostate Cancer Int”
EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. (2020, methodology): “Data from SPCG-4 [101] and a preplanned subgroup analysis (PIVOT) [118] highlight the benefit of RP compared with WW.”