Bill-Axelson A, et al. – In this study, researchers randomized 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999, following-up through 2017, to assess if radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer. According to findings, radical prostatectomy may be beneficial for men with clinically detected, localized prostate cancer, as the investigators noted a long life expectancy, with a mean of 2.9 years of life gained. Death from prostate cancer could be predicted with high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens.

Methods

• Researchers estimated cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis in intention-to-treat and per-protocol analyses, and determined the numbers of years of life gained.
• Using Cox proportional-hazards model, the prognostic value of histopathological measures was assessed.

Results

• By the end of December 2017, death was reported for 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group.
• Prostate cancer caused 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group.
• The number needed to treat to avert one death from any cause was 8.4.
• Radical prostatectomy resulted in a mean of 2.9 extra years of life gain at 23 years.
• Among the men who underwent radical prostatectomy, 5 times higher risk of death from prostate cancer was noted among those with extracapsular extension vs those without extracapsular extension; 10 times higher risk was noted for those with a Gleason score > 7 vs the risk noted for those with a score of ≤ 6 (score range, 2-10; higher scores indicate more aggressive cancer).