1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Prostatectomy vs. Watchful Waiting in Early Prostate Cancer

Compared with watchful waiting, radical prostatectomy resulted in fewer deaths from prostate cancer, but urinary incontinence and decreased sexual function were more common with surgery.

Men with early prostate cancer have a choice of undergoing surgery or radiotherapy, or watchful waiting. This Scandinavian study is the first recent comparative trial: 695 men (mean age, 65) with early prostate cancer were randomized to radical prostatectomy or to watchful waiting. Most tumors (76%) were palpable but were clinically confined to the prostate; the others were discovered by prostate-specific antigen testing (12%) or incidentally during transurethral prostatectomy for benign disease (12%).

During a median follow-up of 6.2 years, death from prostate cancer occurred significantly less often in the surgery group than in the watchful-waiting group (4.6% vs. 8.9%). However, a modest excess of deaths from other causes occurred in the surgical group; thus, all-cause mortality was not significantly different in the 2 groups (15.3% and 17.8%, respectively). Both local progression and distant metastases occurred significantly less often in the surgical group.

In a companion study, patients reported quality-of-life outcomes at an average of 4 years after randomization. Compared with watchful-waiting patients, prostatectomy patients were significantly more likely to report "moderate or great distress" from urinary leakage (9% vs. 29%) and from compromised sexuality (40% vs. 56%). Responses for overall physical and psychological well-being were similar in the 2 groups.

Comment: Based on about 6 years of follow-up, these findings suggest a reduction in prostate-cancer-specific, but not overall, mortality in patients who undergo radical prostatectomy. It will be important to determine whether mortality curves diverge further during additional follow-up. Keep in mind that these figures might not apply to PSA-detected tumors, which accounted for a small fraction of cases in this trial; a similar U.S. study that currently is in progress (the PIVOT trial) includes a larger proportion of men with PSA-detected tumors.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 20, 2002

Citation(s):

Holmberg L et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med 2002 Sep 12; 347:781-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Steineck G et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 2002 Sep 12; 347:790-6.

• Original article (Subscription may be required)
• Medline abstract (Free)