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Radical Prostatectomy Beats Watchful Waiting at 15 Years

Surgery associated with a lower risk of prostate cancer mortality

WEDNESDAY, May 4 (HealthDay News) -- After 15 years, radical prostatectomy appears to be associated with a reduction in the rate of death from prostate cancer as compared to watchful waiting, according to a study published in the May 5 issue of the New England Journal of Medicine.

Anna Bill-Axelson, M.D., Ph.D., of the Uppsala University Hospital in Sweden, and colleagues randomized 695 men with early prostate cancer to watchful waiting or radical prostatectomy between October 1989 and February 1999, with follow-up completed through December 2009.

The investigators found that 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died during a median of 12.8 years. Death was attributable to prostate cancer among 55 men assigned to surgery and 81 men assigned to watchful waiting, with a cumulative incidence of death from prostate cancer at 15 years of 14.6 percent for surgery and 20.7 percent for watchful waiting (relative risk [RR] with surgery, 0.62). The survival benefit was similar before and after nine years of follow-up, was also seen among men with low-risk disease, and was limited to men younger than 65. Men with extracapsular tumor growth who underwent radical prostatectomy had a risk of death from prostate cancer that was seven times that of men without extracapsular tumor growth who underwent the procedure.

"Management of early-stage prostate cancer will continue to require careful consideration of the severity of the disease, the potential benefits and harms of intervention, and the patient's age, health status, and individual preferences," writes the author of an accompanying editorial.

One study author disclosed financial relationships with Pfizer and Astellas.

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