- In localized prostate cancer, surgery vs observation resulted in an absolute reduction of 5.7 percentage points in risk for all-cause mortality and a 1-year increase in mean survival at 18 years.
Why this matters
- Strategies are needed to identify men who will benefit from surgery while reducing ineffective treatment and overtreatment.
- Long-term analysis of the PIVOT trial: 731 patients with localized prostate cancer were randomly assigned to radical prostatectomy or observation.
- Funding: National Cancer Institute; Agency for Health Care Research and Quality.
- Median follow-up for surviving participants, 18.6 years.
- The risk for all-cause mortality was significantly lower with surgery (HR, 0.84 [P=.044]; absolute risk reduction, 5.7 percentage points at 22.1 years).
- The restricted mean survival in the surgical vs observation group was 13.6 vs 12.6 years in the observation group at 22.1 years.
- Absolute all-cause mortality difference between surgery and observation was higher in:
- Patients aged
- Absolute effects and mean survival were greater in men with intermediate-risk disease (13 percentage points and 2.1 years gained, respectively), but not in those with low- and high-risk disease.
- Prostate cancer mortality not reported.