In a nutshell
This study compared mortality rates in patients with localized prostate cancer who were managed with either radical prostatectomy (complete surgical removal of the prostate) or careful clinical observation. Initial diagnosis was made by means of Prostate Specific Antigen (PSA) testing. The main finding was that mortality did not differ significantly between the two groups.
Some background
Prostate cancer is a slow-growing type of cancer, that can sometimes be observed for a while before commencing any treatment. Currently, many patients diagnosed with localized prostate cancer (cancer confined to the prostate gland) are being treated aggressively. Since prostate surgery is frequently associated with complications such as sexual dysfunction and incontinence, a viable alternative consists of careful observation through routine examinations, surgical treatment being offered only when the disease begins to progress.
Methods & findings
The study included 731 men diagnosed with localized prostate cancer. 364 of them Patients undergone radical prostatectomy whereas 367 were assigned to the observation group. Participants were followed up for a maximum of 15 years in order to assess mortality rates. Overall, there was no significant difference between the two groups (47% for surgery; 49.9% for observation), although surgery slightly decreased mortality rate in men with PSA values over 10ng/ml.
The bottom line
As both groups had similar mortality rates, observation has the potential to improve quality of life by reducing unnecessary complications due to surgical interventions, while maintaining excellent long-term survival, especially in men with PSA levels under 10ng/ml.
The fine print
The potential limitations of this study are:
- The study was performed in the early days of PSA testing. Since then, diagnostic protocols have changed, and patients can be better stratified into risk groups.
- The main objective was the assessment of mortality by all causes, specific mortality due to prostate cancer being secondary.
- Overall, the patients involved had higher PSA values compared to other studies.
Published By :
The New England Journal of Medicine
Date :
Jul 19, 2012
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