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Radical Prostatectomy or Watchful Waiting in Prostate Cancer: 29-Year Follow-up
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. Kings Coll London, Sch Med, Div Canc Studies, London, England;Kings Coll London, Sch Canc & Pharmaceut Sci, London, England.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. 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 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 379, no 24, p. 2319-2329Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2018. Vol. 379, no 24, p. 2319-2329
National Category
Urology and Nephrology General Practice
Identifiers
URN: urn:nbn:se:uu:diva-372932DOI: 10.1056/NEJMoa1807801ISI: 000452872600007PubMedID: 30575473OAI: oai:DiVA.org:uu-372932DiVA, id: diva2:1277440
Funder
Swedish Cancer Society, 07 05 12 CAN 2014/1275The Karolinska Institutet's Research FoundationAvailable from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-01-10Bibliographically approved

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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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UrologyEndocrine SurgeryUCR-Uppsala Clinical Research CenterDepartment of Immunology, Genetics and Pathology
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New England Journal of Medicine
Urology and NephrologyGeneral Practice

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