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Prostatectomy vs. Watchful Waiting in Early Prostate Cancer: An Update

During a median follow-up of 8 years, prostatectomy was associated with lower mortality (both disease-specific and overall) than watchful waiting was.

In 2002, Scandinavian researchers reported outcomes for 695 men with early prostate cancer who had been randomized to either radical prostatectomy or watchful waiting (Journal Watch Sep 20 2002). After an average follow-up of 6 years, prostate cancer mortality — but not all-cause mortality — was significantly lower with prostatectomy than with watchful waiting. Now, the investigators have reported outcomes after a median follow-up of 8.2 years.

For each of the four main endpoints, the estimated 10-year cumulative incidence was significantly lower in the prostatectomy group than in the watchful-waiting group:

• Death from prostate cancer: 10% vs. 15%
  
• All-cause mortality: 27% vs. 32%
  
• Local progression: 19% vs. 44%
  
• Distant metastases: 15% vs. 25%
  

In subgroup analyses, benefit of radical prostatectomy appeared to be limited to men younger than 65 at diagnosis, but the authors considered this analysis to be only exploratory.

Comment: These are the best available randomized-trial data on the benefit of radical prostatectomy in patients with early prostate cancer. The results, however, might not apply to all patients because: (1) most of these cancers were palpable, with only 12% detected by prostate-specific antigen (PSA) testing alone; (2) all patients were in relatively good health; and (3) the tumors all were well differentiated or moderately well differentiated. A similar U.S. study (called PIVOT) includes a larger proportion of patients with PSA-detected tumors, but its results will not be available for several more years.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 20, 2005

Citation(s):

Bill-Axelson A et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005 May 12; 352:1977-84.

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