Radical prostatectomy vs. watchful waiting

To determine any differences in survival times, the Scandinavian Prostate Cancer Group Study Number 4 randomly assigned 695 prostate cancer patients to pursue watchful waiting or undergo a radical prostatectomy between 1989 and 1999. The average age of participants was 65.

In 2002, when the initial results were published after a median follow-up time of about six years, researchers reported that surgery significantly reduced the chances of dying from prostate cancer. However, there was no difference in overall survival between the two groups. After tracking the men for a few more years, researchers reported in 2005 that patients who had had surgery were significantly less likely to die from prostate cancer and from all other causes than the watchful waiting group.

In August 2008, researchers reported on study participants for the third time. After more than a decade of follow-up, 13.5% of the men who’d had surgery had died from prostate cancer, compared with 19.5% in the watchful waiting group. After 12 years, researchers estimated, any difference in overall mortality between the groups would not be statistically significant.

One caveat: only 12% of study participants had their cancers detected with prostate-specific antigen (PSA) testing. The rest had cancers that could be felt during a digital rectal exam, meaning that they had relatively more advanced tumors. Whether the findings would be similar for asymptomatic men with cancers diagnosed through PSA screening remains unclear.

SOURCES: Bill-Axelson A, Holmberg L, Filén, F, et al. Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: The Scandinavian Prostate Cancer Group-4 Randomized Trial. Journal of the National Cancer Institute 2008;100:1144–54. PMID: 18695132.

Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical Prostatectomy Versus Watchful Waiting in Early Prostate Cancer. New England Journal of Medicine 2005;352:1977–84. PMID: 15888698.

Holmberg L, Bill-Axelson A, Helgesen F, et al. A Randomized Trial Comparing Radical Prostatectomy with Watchful Waiting in Early Prostate Cancer. New England Journal of Medicine 2002;347:781–89. PMID: 12226148.