Radical prostatectomy is associated with a substantial long-term reduction in mortality in men with localized cancer, especially in younger patients, according to newly published data from one of the few randomized trials to directly address the surgery-versus-surveillance issue.
The article, by researchers from Uppsala University Hospital, Sweden, Harvard School of Public Health, Boston, and colleagues, appears in this week’s New England Journal of Medicine (2014; 370:932-42).
While the benefit on mortality appears to be limited to men under age 65 years, surgery did reduce the risk of metastases and need for additional treatment in older men. The study’s release lit up Twitter, drawing wide-ranging commentary from urologists in the U.S. and abroad.
The researchers used data from the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), which randomized 695 men with early prostate cancer to treatment with surgery or watchful waiting with no initial treatment, with follow-up for up to 24 years. Over the course of the study, 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 (relative risk: 0.56; 95% confidence interval: 0.41-0.77; p=.001).
The number needed to treat to prevent one death at 18 years of follow-up was eight.
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