Estimated 15-year results from the Scandinavian Prostate Cancer Group Study (SPCG-4) show that men diagnosed with early prostate cancer and randomly assigned to radical prostatectomy continued to have significantly reduced rates of death from prostate cancer, death from any cause, and risk of metastases than did men randomly assigned to watchful waiting. “The benefit is obvious among men younger than 65 years of age, but it is still unclear whether the benefit extends to older men,” the investigators reported in The New England Journal of Medicine. “The finding that the effect of radical prostatectomy is modified by age has not been confirmed in other studies of radical prostatectomy or external-beam radiation, the authors added.
During a median of 12.8 years, 201 of the 348 men randomly assigned to the watchful waiting group died (81 due to prostate cancer) and 166 of the 347 men in the radical prostatectomy group died (55 due to prostate cancer). The risk of death from prostate cancer after radical prostatectomy was 7 times higher among men who had tumors with extracapsular growth. “Although extracapsular growth is not a perfect predictor of lethal disease, our findings indicate that these men could be a group for which adjuvant local or systemic therapy would be beneficial,” the authors stated.
“The finding that some low-risk tumors will progress and become lethal emphasizes the importance of protocols with well-defined end points at which men in active surveillance switch to curative treatment,” the authors concluded. “With continued follow-up, data from the SPCG-4 study may allow us to identify prognostic markers in men assigned to watchful waiting that can serve as trigger points for active treatment; the prognostic value of these markers can then be validated in cohorts that are under active surveillance.”
Bill-Axelson A, et al: New Engl J Med 364:1708-1717, 2011.