- Radical prostatectomy (RP) is associated with a mean 2.9 extra years of life, at 23 years, vs watchful waiting in men with localized prostate cancer (PCa).
- RP yielded significant lower cancer-specific mortality and risk for metastasis; factors for poor prognosis included extracapsular extension and higher Gleason score.
Why this matters
- Life expectancy should be considered while recommending treatment in these patients.
- In Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), 695 men (age, T1b, T1c, or T2 PCa were randomly assigned to watchful waiting or RP during 1989-1999.
- Funding: Swedish Cancer Society; NIH.
- Follow-up time, 29.3 years.
- At 23 years:
- Cumulative incidence of death from PCa was significantly lower in the RP group (19.6% vs 31.3%; relative risk [RR], 0.55; P<.001>
- Cumulative incidence of distant metastases was 26.6% vs 43.3% (RR, 0.54; P<.001>
- Mean life years gained with RP, 2.9 years.
- Extracapsular extension (RR, 5.21; 95% CI, 2.42-11.22).
- Gleason score 4+3 (RR, 5.73; 95% CI, 1.59-20.67) or 8-9 (RR, 10.63; 95% CI, 3.03-37.30).
- Study began before broad use of the PSA test was adopted.