Radical prostatectomy did not significantly reduce all-cause mortality or prostate cancer mortality compared with observation through several years of follow-up among men with localized prostate cancer often detected by prostate-specific antigen (PSA) testing, a new study indicates.
A total of 731 men (mean age, 67 years) with localized prostate cancer (median PSA value, 7.8 ng per milliliter) were randomized to radical prostatectomy or to observation from November 1994 through January 2002, and were followed through January 2010. During the median follow-up of 10 years, 171 of 364 men (47%) assigned to radical prostatectomy died, compared with 183 of 367 men (49.9%) in the observation group. Adverse events within 30 days after surgery, including one death, occurred in 21.4% of patients.
In the radical prostatectomy group, 21 men (5.8%) died from prostate cancer or treatment, compared with 31 men (8.4%) assigned to observation. The effect of treatment on all-cause and prostate cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor, but radical prostatectomy was associated with reduced all-cause mortality among men with a PSA value greater than 10 ng per milliliter, and possibly among men with intermediate-risk or high-risk tumors (N Engl J Med. 2012;367:203-213).