An aggressive treatment approach for men with clinically detected, localized prostate cancer may add years to their lives, a new long-term study suggests.
Between October 1989 and February 1999, 695 men with localized prostate cancer were randomized to either undergo radical prostatectomy (n = 347) or opt for “watchful waiting” (n = 348) Follow-up data were collected through 2017. Researchers analyzed all-cause mortality, death from prostate cancer, and metastasis in intention-to-treat and protocol analysis, and they estimated number of life years gained.
At 23 years of follow-up, mortality among men who underwent radical prostatectomy was 11.7 percentage points lower than that among men whose condition was managed by watchful waiting. Radical prostatectomy was associated with a mean of nearly 3 years of extra life.
— NEJM (@NEJM) December 12, 2018
At final follow-up, 261 radical prostatectomy patients and 292 watchful waiting patients had died. Of the radical prostatectomy deaths, 71 were due to prostate cancer, and 110 watchful waiting patients died from prostate cancer (relative risk, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001; absolute difference in risk, 11.7 percentage points; 95% CI, 5.2 to 18.2). After 23 years, radical prostatectomy patients gained an average additional 2.9 years of life. Radical prostatectomy patients who underwent extracapsular extension were five times more likely to die from prostate cancer than those who did not. Patients with a Gleason score higher than 7 were 10 times as likely to die from prostate cancer than those whose score was 6 or lower.
The study’s findings do not apply to low-risk patients or unhealthy patients, said lead study author Dr. Anna Bill-Axelson of Uppsala University in Sweden.
— Eric Topol (@EricTopol) December 12, 2018
“What we show is that radical prostatectomy can cure prostate cancer but it’s only for those who develop a lethal disease and who are healthy enough to not die from something else,” Bill-Axelson told Reuters.
“Even in our study with advanced tumors, almost 70 percent of the men died from other causes, so it shows you shouldn’t treat immediately, especially low- or intermediate-risk tumors,” she added. “You should wait and see if they get more aggressive and then treat them.”
Men who were diagnosed before they turned 65 were most likely to benefit, according to the study authors; of these patients, “overall mortality was 15 percentage points lower, mortality due to prostate cancer was 15.1 percentage points lower, and the risk of metastasis was 18.6 percentage points lower in the radical-prostatectomy group than in the watchful-waiting group.”