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Radical Prostatectomy or Watchful Waiting in Prostate Cancer: 29-Year Follow-up
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Kings Coll London, Sch Med, Div Canc Studies, London, England;Kings Coll London, Sch Canc & Pharmaceut Sci, London, England.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Kings Coll London, Sch Med, Div Canc Studies, London, England.ORCID-id: 0000-0001-7181-7083
Helsinki Univ Hosp, Dept Urol, Helsinki, Finland.
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2018 (Engelska)Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 379, nr 24, s. 2319-2329Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term followup is sparse.

METHODS We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model.

RESULTS By December 31, 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died; 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to prostate cancer (relative risk, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001; absolute difference in risk, 11.7 percentage points; 95% CI, 5.2 to 18.2). The number needed to treat to avert one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life were gained with radical prostatectomy. Among the men who underwent radical prostatectomy, extracapsular extension was associated with a risk of death from prostate cancer that was 5 times as high as that among men without extracapsular extension, and a Gleason score higher than 7 was associated with a risk that was 10 times as high as that with a score of 6 or lower (scores range from 2 to 10, with higher scores indicating more aggressive cancer).

CONCLUSIONS Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer.

Ort, förlag, år, upplaga, sidor
2018. Vol. 379, nr 24, s. 2319-2329
Nationell ämneskategori
Urologi och njurmedicin Allmänmedicin
Identifikatorer
URN: urn:nbn:se:uu:diva-372932DOI: 10.1056/NEJMoa1807801ISI: 000452872600007PubMedID: 30575473OAI: oai:DiVA.org:uu-372932DiVA, id: diva2:1277440
Forskningsfinansiär
Cancerfonden, 07 05 12 CAN 2014/1275Karolinska Institutets ForskningsstiftelseTillgänglig från: 2019-01-10 Skapad: 2019-01-10 Senast uppdaterad: 2019-01-10Bibliografiskt granskad

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Bill-Axelson, AnnaHolmberg, LarsGarmo, HansBusch, ChristerHäggman, Michael

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Bill-Axelson, AnnaHolmberg, LarsGarmo, HansBusch, ChristerHäggman, Michael
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UrologkirurgiEndokrinkirurgiUppsala kliniska forskningscentrum (UCR)Institutionen för immunologi, genetik och patologi
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