Radical prostatectomy linked to long-term survival gains
medwireNews: Men with localised prostate cancer derive long-term survival benefits from radical prostatectomy relative to watchful waiting, indicate the 29-year follow-up results of the SPCG-4 trial.
At this timepoint, “when 80% of all the participants had died, lower overall mortality, lower mortality due to prostate cancer, and a lower risk of metastasis prevailed in the radical-prostatectomy group”, write Anna Bill-Axelson, from Uppsala University Hospital in Sweden, and co-investigators in The New England Journal of Medicine.
The trial enrolled 695 patients with clinically detected, localised disease from 14 centres in Sweden, Finland and Iceland, and randomly assigned them to undergo either radical prostatectomy or watchful waiting between October 1989 and February 1999. Trial participants were followed up for a median of 23.9 years and a maximum of 29.3 years.
In the intention-to-treat analysis, 71.9% of 347 men in the radical prostatectomy group had died at the 23-year mark, as had 83.8% of the 348 patients who were assigned to undergo watchful waiting. This equated to a significant hazard ratio (HR) for death of 0.74 in favour of radical prostatectomy.
Similarly, radical prostatectomy was associated with a significantly reduced risk of prostate cancer-related mortality and distant metastases relative to watchful waiting, with 23-year rates of 19.6% versus 31.3% and 26.6% versus 43.3%, respectively, and corresponding HRs of 0.55 and 0.54.
The findings were similar in the per-protocol analysis, indicating that the “main results do not reflect the possible effects of systematic patterns of nonadherence”, say the study authors.
The researchers estimated that men who underwent radical prostatectomy gained an average 2.9 years of life. Although this is “a crude measure”, they say, it “puts in perspective what is risked by delaying intervention.”
Bill-Axelson and colleagues admit that there are differences between now and when the trial was conducted with regard to diagnostic procedures, prostate-specific antigen testing and other factors.
The team continues: “When our results are applied to inform current practice, several issues have to be considered: the lead time induced by screening, the addition to modern cohorts of overdiagnosed nonlethal cancers, and the influence of modern diagnostics on the definition of risk groups.
“Furthermore, even if the relative risks in our trial were fully applicable to modern studies, the amount of absolute benefit is highly dependent on baseline risk.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group