Radical Prostatectomy Shows Long-Term Survival Benefit

A long-term study from the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) revealed that men with localized prostate cancer who underwent radical prostatectomy lived significantly longer than those managed with active surveillance (“watchful waiting”). Among 695 men randomized between 1989 and 1999, those who had surgery gained an average of 2.9 years of life over 23.6 years of follow-up. Prostate cancer mortality was lower in the surgery group (71 deaths) compared to the observation group (110 deaths), with a relative risk reduction of 45%.

The incidence of distant metastases was also significantly lower in the prostatectomy group (26.6%) versus the watchful waiting group (43.3%). Notably, extracapsular extension and high Gleason scores were strong predictors of death from prostate cancer.

Despite these compelling outcomes, experts caution against overgeneralizing the findings to current patients. Diagnostic and treatment methods have evolved since the 1990s. Dr. James Mohler noted that modern early detection, largely through PSA testing, could lead to overtreatment in cases that may not require intervention. Additionally, the study did not stratify results by Gleason score or report current adverse effects like incontinence or erectile dysfunction.

Still, the study provides strong evidence that for patients with aggressive prostate cancer, radical prostatectomy offers significant survival benefits over watchful waiting. However, the applicability of these results to today’s clinical practice remains debated, particularly for low-risk patients who might benefit more from active surveillance.

Overall, this landmark study highlights the importance of personalized treatment decisions in prostate cancer care.

Bassett, M. (2018, December 12). Prostatectomy beats active surveillance long term — or does it? The 29‑year follow‑up makes data hard to interpret. MedPage Today. Retrieved from https://www.medpagetoday.com/urology/prostatecancer/76873