July 23, 2012

Prostate Cancer: Surgery vs. Observation

(Ivanhoe Newswire) — In a study reported by the New England Journal of Medicine, researchers tried to determine which course of action is more beneficial for men diagnosed with localized prostate cancer through the prostate-specific antigen (PSA) test: radical prostatectomy or observation without surgery?

From November 1994 through January 2002, researchers randomly assigned 731 men with localized prostate cancer to radical prostatectomy or observation and followed them through January 2010. The primary outcome was all-cause mortality, and the secondary outcome was prostate-cancer mortality.

Researchers found that during the median follow-up of 10 years, 171 of 364 men (47%) died compared with 183 of 367 (49.9%) assigned to observation. Among the men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment compared with 31 men (8.4%) assigned to observation. The treatment´s effects on all-cause and prostate cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor. Radical prostatectomy was associated with reduced all-cause mortality among men who had a PSA value greater than 10 nanometers per milliliter and possibly among those with intermediate-risk or high-risk tumors. After 30 days of the surgery, 21.4% of men experienced adverse effects, including one death.

Researchers concluded that radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality compared with observation through at least 12 years of follow up. Though surgery had slightly more positive effects, absolute differences were only less than 3 percentage points.

Source: New England Journal of Medicine, July 2012