Radical prostatectomy for early prostate cancer offers no overall survival benefit over watchful waiting, nor is quality of life different, according to the results of two studies reported in the Sept. 12 issue of the New England Journal of Medicine.
However, cancer-related deaths and metastases are fewer in patients undergoing radical surgery. “The management of early prostate cancer is controversial,” write Lars Holmberg, MD, PhD, from the Scandinavian Prostatic Cancer Group Study Number 4, and colleagues.
“The choice of therapy is complex, and patients need complete information about the alternatives; in addition, physicians need to know about individual patients’ concerns.”
From October 1989 through February 1999, a total of 695 men with newly diagnosed prostate cancer, stage T1b, T1c, or T2, were randomized to radical prostatectomy or watchful waiting. During a median of 6.2 years of follow-up, 53 men who had surgery died, as did 62 men who did not have surgery (P=.31).
Prostate cancer-specific mortality was 4.6% in the radical prostatectomy group and 8.9% in the watchful waiting group (relative hazard, 0.50; 95% confidence interval [CI], 0.27-0.9; P=.02). Risk reduction of distant metastases was 37% in the surgical group (relative hazard, 0.63; 95% CI, 0.41-0.96).
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