Localized prostate cancer: surgery improves survival in long term

  • Wilt TJ & et al.
  • Eur Urol
  • 17 Feb 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Prostate cancer mortality not reported.