Prostatectomy benefit confirmed

Radical prostatectomy improves survival compared with watchful waiting in otherwise healthy men with localised prostate cancer, according to a 28-year follow-up study published in the New England Journal of Medicine (2018;379:2319–29).

Researchers randomly assigned 695 men with localised prostate cancer to watchful waiting or radical prostatectomy from October 1989 to February 1999 and collected follow-up data through to 2017.

By December 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died. Seventy-one deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to prostate cancer (relative risk, 0.55; 95% CI 0.41–0.74; p<0.001). The number needed to treat to prevent one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life were gained with radical prostatectomy.

Among the men who underwent radical prostatectomy, extracapsular extension was associated with a risk of death from prostate cancer that was five times as high as that among men without extracapsular extension. A Gleason score higher than 7 was associated with a risk of death from prostate cancer that was 10 times as high as that with a score of 6 or lower.

According to the authors, radical prostatectomy reduces mortality among men with clinically-detected localised prostate cancer, but evidence from randomised trials with long-term follow-up is sparse. This study helps confirm the benefit.

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