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Health See other Health Articles Title: Active surveillance versus radical prostatectomy for localized prostate cancer Medscape: The question of whom to treat for diagnosed prostate cancer continues to challenge us in our medical practices with our patients. I found the recent article by T. Wilt and coauthors reporting on the PIVOT study (New England Journal of Medicine 367:203, 2012) to be very helpful in resolving these questions. 731 men with localized prostate cancer who were a mean age of 67 years old were randomized to radical prostatectomy versus observation. All men eligible for the study had to have a life expectancy of at least 10 years. The authors followed these individuals for both overall, and cancer-specific mortality. The median follow up was 10 years, indicating a very mature study. Overall, men who received radical prostatectomy did not have a survival advantage compared to men who were assigned to active surveillance. The men who received active surveillance could receive subsequent therapy if they had progression, but were usually offered only palliative therapy or chemotherapy for symptomatic progression or metastatic disease. The hazard ratio for survival was 0.88 (p-0.22), an insignificant and meaningless level of significance. However, among certain patients it appeared that radical prostatectomy was extremely important. For men whose PSA level was over 10, the hazard ratio was 0.36 (P still only 0.11, indicating only a trend). This indicates a possible reduction in risk of prostate cancer-specific death of 64%. In addition, in men with intermediate or high-risk disease, the hazard ratio was 0.50 and 0.40, respectively (p=0.11, indicating only a trend). It thus appears that by selecting men with high PSA or intermediate or high-risk disease, the use of radical prostatectomy suggested a strong trend for benefit. Of course, toxicity in the radical prostatectomy group was substantially higher. Urinary incontinence was almost 3x greater (17.1% versus 6.3% at 2 years), as well as erectile dysfunction (81.1% versus 44.1%). Therefore, careful selection of men for consideration of radical prostatectomy is appropriate, and discussion of side effects of therapy is necessary. In my practice, young men with intermediate or high-risk disease or high PSA are always advised to strongly consider robotic prostatectomy, and men over 65 years with high PSA or high-risk disease are advised to consider radiation therapy. When prostate cancer patients do not fall into this category (they have only low risk disease ), they are followed with active surveillance including PSA monitoring and annual rebiopsy to detect progression to a more aggressive form of prostate cancer. Post Comment Private Reply Ignore Thread Top • Page Up • Full Thread • Page Down • Bottom/Latest
#1. To: Tatarewicz (#0)
I would've thought there'd more interest here in this article.
"Mr. Prime Minister, there is only one important question facing us, and that is the question whether the white race will survive." -- Leonid Brezhnev to James Callahan
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