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Radical Prostatectomy or Watchful Waiting in Prostate Cancer-29-Year Follow-up
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; School of Medicine, Division of Cancer Studies, Sweden hSchool of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom.
Regional Cancer Center Uppsala, Uppsala University Hospital, Uppsala, Sweden; School of Medicine, Division of Cancer Studies, Sweden, London, United Kingdom.
Department of Urology, Helsinki University Hospital, Helsinki, Finland..
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2018 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 379, no 24, p. 2319-2329Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term followup is sparse.

METHODS: We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model.

RESULTS: By December 31, 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; 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to 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). The number needed to treat to avert 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 5 times as high as that among men without extracapsular extension, and a Gleason score higher than 7 was associated with a risk that was 10 times as high as that with a score of 6 or lower (scores range from 2 to 10, with higher scores indicating more aggressive cancer).

CONCLUSIONS: Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer.

Place, publisher, year, edition, pages
Massachussetts Medical Society , 2018. Vol. 379, no 24, p. 2319-2329
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-71140DOI: 10.1056/NEJMoa1807801ISI: 000452872600007PubMedID: 30575473Scopus ID: 2-s2.0-85058544380OAI: oai:DiVA.org:oru-71140DiVA, id: diva2:1276555
Funder
Swedish Cancer Society, 07 05 12 CAN 2014/1275Swedish National Institute of Public Health, 1ROI CA 108746-01A1
Note

Funding Agencies:

Karolinska Institutet  2368/10-221 

Percy Falk Foundation  

Örebro lans landsting  

Swedish Cancer Society (Senior Investigator Award CAN 2014)  

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-08Bibliographically approved

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Andrén, Ove

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