Extended follow-up confirms that radical prostatectomy continues to substantially reduce mortality from any cause, mortality from prostate cancer, and the risk of developing metastases over the long term, compared with watchful waiting, investigators reported March 5 in the New England Journal of Medicine.
These protective effects were most pronounced in men who were under age 65 at diagnosis, but older men had the additional benefit from radical prostatectomy of improved quality of life, because of a significantly lower risk of palliative care, including androgen-deprivation therapy. "The life experience after the diagnosis of prostate cancer differs substantially between the two study groups and evolves over decades," said Dr. Anna Bill-Axelson of Uppsala (Sweden) University Hospital and her associates.
Between 1989 and 1999, men with localized prostate cancer who were under age 75 and had life expectancies beyond 10 years, were randomly assigned to undergo radical prostatectomy (347 patients) or watchful waiting (348 patients) at 14 medical centers in Sweden, Finland, and Iceland. A total of 447 men (64%) died during extended follow-up lasting until 2012 (median follow-up, 13.4 years).
All-cause mortality was 56.1% in the prostatectomy group, significantly lower than the 68.9% all-cause mortality in the watchful waiting group; the number needed to treat to prevent 1 death at 18 years of follow-up was 8. Similarly, prostate cancer–specific mortality was 17.7% with prostatectomy vs. 28.7% with watchful waiting, and the difference between the two study groups continued to increase over time, the investigators reported (N. Engl. J. Med. 2014 March 5 [doi: 10.1056/NEMoa1311593]).
Among men under age 65 at diagnosis, all-cause mortality was 25.5 percentage points lower, prostate cancer–specific mortality was 15.8 percentage points lower, and risk of metastases was 15.8 percentage points lower with prostatectomy than with watchful waiting. "In this age group, the number needed to treat to prevent 1 death from prostate cancer was 4," Dr. Bill-Axelson and her associates said.
This study was supported by the Swedish Cancer Society, the National Institutes of Health, the Karolinska Institute, the Prostate Cancer Foundation, and the Percy Falk Foundation. The authors reported that they had no financial conflicts of interest.