Radical prostatectomy in early prostate cancer improves 10-year outcomes

Compared with watchful waiting for patients with prostate cancer, radical prostatectomy is associated with reduced risk of disease progression and death over the ensuing 10 years, investigators report. The reduced incidence of death from prostate cancer is particularly evident among men younger than 65 years.

Dr. Anna Bill-Axelson, of University Hospital in Uppsala, Sweden, and associates previously reported that radical prostatectomy reduces mortality due to prostate cancer after a median of 6.2 years, although overall survival was not significantly affected. Now, in the May 12th issue of The New England Journal of Medicine, Dr. Bill-Axelson's group reports on the 10-year estimates for this same cohort, which included 347 men younger than 75 years randomly assigned to radical prostatectomy and 348 to watchful waiting.During follow-up, 30 men in the prostatectomy group and 50 in the expectant waiting group died of prostate cancer (p = 0.01), for a relative risk of 0.56.At 5-year follow-up, the cumulative incidence of distant metastases had been similar in the two groups. By 10 years, the relative risk was 0.60 (p = 0.004). The relative risk for local progression was 0.33 (p < 0.001), and for overall mortality was 0.74 (p = 0.04).Moreover, the cumulative incidence of death among men below age 65 was 19.2% in the watchful-waiting group versus 8.5% to 11.5% for other subgroups.While the reduction in mortality is moderate, the authors expect the benefits of surgery will increase during longer follow-up."The more immediate, though stable, side effects associated with surgery...should be weighed against the increasing incidence of symptoms and use of treatments after the progression of disease in the watchful-waiting group," they advise.(Source: N Engl J Med 2005;352:1977-1984: Reuters Health: Oncolink: June 2005.)