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Results from the scandinavian prostate cancer group trial number 4: a randomized controlled trial of radical prostatectomy versus watchful waiting
Regional Cancer Center Uppsala/Örebro, Uppsala, Sweden; Division of Cancer Studies, Medical School, King’s College London, London, UK; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden .
Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology Karolinska Institute, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden .
Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Gothenburg, Sweden .
Regional Cancer Center Uppsala/Örebro, Uppsala, Sweden; Division of Cancer Studies, Medical School, King’s College London, London, UK .
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2012 (English)In: Journal of the National Cancer Institute. Monographs, ISSN 1052-6773, E-ISSN 1745-6614, Vol. 2012, no 45, p. 230-233Article in journal (Refereed) Published
Abstract [en]

In the Scandinavian Prostate Cancer Group Trial Number 4 (SPCG-4), 347 men were randomly assigned to radical prostatectomy and 348 to watchful waiting. In the most recent analysis (median follow-up time = 12.8 years), the cumulative mortality curves had been stable over the follow-up. At 15 years, the absolute risk reduction of dying from prostate cancer was 6.1% following randomization to radical prostatectomy, compared with watchful waiting. Hence, 17 need to be randomized to operation to avert one death. Data on self-reported symptoms, stress from symptoms, and quality of life were collected at 4 and 12.2 years of median follow-up. These questionnaire studies show an intricate pattern of symptoms evolving after surgery, hormonal treatments, signs of tumor progression, and also from natural aging. This article discusses some of the main findings of the SPCG-4 study. The Scandinavian Prostate Cancer Group Trial Number 4 (SPCG-4) started in 1989 when radical prostatectomy was newly introduced in Scandinavia and when there was essentially no prostate-specific antigen (PSA) testing in asymptomatic men; such testing only became common at the end of the inclusion of the trial a decade later. However, the trial data continue to be important for several reasons. In many parts of the world, the clinical panorama of prostate cancer still resembles that in Sweden in the early 1990s. The trial results point to many of the issues that modern diagnosis and treatment have to solve. SPCG-4 is to date the only trial to inform about both forces of mortality and self-reported symptoms and quality of life in men after radical prostatectomy or watchful waiting two decades and more out after a primary diagnosis of prostate cancer. According to the protocol (http://www.roc.se/prostata/SPCG-4.pdf), the main trial data have been updated every 3 years since 2002 (1–6). In this presentation, we highlight some of the main findings with bearing on the topic of this conference and discuss some issues that have been raised when the trial results have been presented.

Place, publisher, year, edition, pages
Cary, USA: Oxford University Press, 2012. Vol. 2012, no 45, p. 230-233
National Category
Medical and Health Sciences Cancer and Oncology Urology and Nephrology
Research subject
Medicine
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URN: urn:nbn:se:oru:diva-27457DOI: 10.1093/jncimonographs/lgs025PubMedID: 23271778Scopus ID: 2-s2.0-84871757326OAI: oai:DiVA.org:oru-27457DiVA, id: diva2:603771
Available from: 2013-02-06 Created: 2013-02-06 Last updated: 2018-05-12Bibliographically approved

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Holmberg, LarsJohansson, Jan-Erik

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