PCa: RP nets extra 3 years of life vs watchful waiting in SPCG-4

  • Bill-Axelson A & et al.
  • N Engl J Med
  • 13 Dec 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.
  • In men undergoing RP, significant predictors for worse PCa-specific mortality were:
    • 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).

Limitations

  • Study began before broad use of the PSA test was adopted.

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