Radical prostatectomy for localized disease extends life by nearly 3 years
medwireNews: Radical prostatectomy extends life by nearly 3 years compared with watchful waiting for men with clinically detected, localized prostate cancer, show long-term data from the SPCG-4 study.
The SPCG-4 study took place between 1989 and 1999, during which time 695 men aged 75 years and younger with localized prostate cancer and a life expectancy of more than 10 years were randomly assigned to undergo radical prostatectomy or watchful waiting.
At 23 years, 71.9% of 347 men in the radical prostatectomy group and 83.8% of 348 in the watchful waiting group had died, equating to a significant 26% reduced risk for death with radical prostatectomy.
Furthermore, the cumulative incidence of prostate cancer death at 23 years was a significant 11.7 percentage points lower with radical prostatectomy than with watchful waiting (19.6 vs 31.3%), which corresponded to a 45% lower risk among the patients who underwent surgery.
There was a similarly reduced risk for distant metastases, at 46%, and the researchers calculated that radical prostatectomy afforded men an additional 2.9 years of life compared with watchful waiting.
The researchers also investigated other disease-related predictors of mortality among the men who underwent radical prostatectomy immediately and found that those with extracapsular extension had a 5.21-fold higher risk for prostate cancer death than men without extracapsular extension.
In addition, men with a Gleason score above 7 were 10.63 times more likely to die from prostate cancer as those with a score of 6 or lower.
Writing in The New England Journal of Medicine, Anna Bill-Axelson (Uppsala University Hospital, Sweden) and colleagues say that their findings highlight “the importance of taking the expected remaining lifetime into account when recommending treatment,” but accept that life expectancy is hard to predict.
They also point out that “the diagnostic procedures used today differ drastically from those used during the period of enrollment” in their study.
Therefore, “[w]hen our results are applied to inform current practice, several issues have to be considered: the lead time induced by screening, the addition to modern cohorts of overdiagnosed nonlethal cancers, and the influence of modern diagnostics on the definition of risk groups,” Bill-Axelson et al remark.
“Furthermore, even if the relative risks in our trial were fully applicable to modern studies, the amount of absolute benefit is highly dependent on baseline risk,” the team concludes.
By Laura Cowen
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