Prostatectomy extends survival in men with early-stage disease

Men with early prostate cancer who undergo radical prostatectomy have a lower rate of death from prostate cancer than do men who undergo watchful waiting, according to a study published in the Journal of the National Cancer Institute (2008: 100:1144-54).

Prostate cancer death rates remained constant beyond 10 years, but the overall death rates in the two groups were not statistically different.

The Scandinavian Prostate Cancer Group launched this study in 1989 to examine the impact of radical prostatectomy compared to watchful waiting on cancer-specific mortality. In 2005, with a median follow-up of 8.2 years, researchers reported that men in the prostatectomy arm had lower rates of disease-specific mortality than those in the watchful waiting arm did.

At median follow-up of 10.8 years, the cumulative incidence rate for prostate cancer death was 13.5% in the surgery arm and 19.5% in the watchful waiting arm, for an absolute reduction of 6%. Absolute risk reduction did not increase after the first 10 years following treatment. Among patients followed at least 12 years, 12.5% of the men in the surgery group died of prostate cancer compared with 17.9% of the men in the watchful waiting group, for an absolute reduction of 5.4%. However, overall mortality between the groups at 12 years was not statistically significantly different.

The authors said it was unclear whether their data are applicable to men whose cancer is detected in the era of PSA screening because most men in their trial had palpable tumors at diagnosis.

“In settings with a large proportion of PSA-detected tumors, the relative reduction in risk of death following radical prostatectomy might be somewhat larger or similar to that in our study, but the absolute reduction would be smaller,” they wrote.