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Prostate cancer surgery preferable to watchful waiting reports new study

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Last year, a study reported that some men with prostate cancer should take a stance of watchful waiting rather than undergoing surgery. Now, a new study, termed the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), suggests that a radical prostatectomy reduces mortality among men with localized prostate cancer. The findings were published on March 6 in The New England Journal of Medicine by Swedish researchers.

Between 1989 and 1999, the researchers randomly assigned 695 men with early prostate cancer to either watchful waiting or radical prostatectomy. The subjects were followed through the end of 2012; the primary end points were death from any cause, death from prostate cancer, and the risk of metastases (spread to other parts of the body). The secondary end points included the implementation of androgen-deprivation (male hormone deprivation) therapy.

The investigators found that during 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Among those the deaths, 63 men in the surgery group and 99 men succumbed to prostate cancer. The men in the surgery group had a risk of 0.56, compared to 1 for the watchful-waiting group. The absolute difference was 11.0 percentage points. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent surgery (a 25.0% difference. The benefit of surgery for reduction of death from prostate cancer was largest in men younger than 65 years of age (0.45, compared to 1) and in those with intermediate-risk prostate cancer (0.38 compared to 1). However, radical prostatectomy was associated with a reduced risk of metastases in older men (0.68 compared to 1).

The authors concluded that extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy. In addition, the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. They also noted that a large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Palliative treatment is designed to provide comfort, rather than a cure.)

Take home message:
If you are diagnosed with prostate cancer, seek out a qualified specialist in the disease and obtain a second opinion, if necessary. Physicians affiliated with the UCLA Health System meet high standards.

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