Substantial long-term reduction in mortality for men with localized prostate cancer who undergo a radical prostatectomy was found by a new study. Although the benefit on mortality appears to be limited to men younger than 65 years, surgery did reduce the risk of metastases and need for additional treatment in older men.

More than 230,000 men will be diagnosed with prostate cancer this year in the United States, but determining their course of treatment remains a source of considerable debate. This new study by researchers from Uppsala University Hospital, Sweden, Harvard School of Public Health (HSPH), and colleagues—drew from one of the few randomized trials conducted to directly address this issue.

The article appeared in the New England Journal of Medicine (2014; doi:10.1056/NEJMoa1011967).

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The researchers used data from the Scandinavian Prostate Cancer Group Study Number 4, which randomized 695 men with early prostate cancer to treatment with surgery or watchful waiting with no initial treatment, with follow-up for up to 24 years.

Over the course of the study, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful waiting group were due to prostate cancer.

“The latest results from the SPCG-4 trial indicate that surgery can not only improve survival, especially in men diagnosed at a younger age or with intermediate-risk disease, but also that surgery can reduce the burden of disease in terms of development of metastases and the need for palliative treatment,” said coauthor Jennifer Rider, ScD, MPH, assistant professor in the Department of Epidemiology at HSPH and assistant professor of medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital in Boston, Massachusetts.

“However, a large proportion of men in the trial still alive at 18 years did not require initial surgery or any subsequent therapy, pointing to the potential benefits of active surveillance strategies to limit overtreatment,” noted Rider.