Radical Prostatectomy decreases risk of metastasis

A new study published in the journal NEJM has reported that there was a significantly decreased risk of metastases and the need for palliative treatment among men older than 65 years of age who underwent radical prostatectomy.

The Swedish researchers have reported that long-term follow-up of prostate cancer patients randomized to radical prostatectomy vs watchful waiting showed a statistically significant survival advantage for the surgical procedure.

The study included 695 men out of which 347 were randomly assigned to the radical prostatectomy group and 348 to the watchful-waiting group. In the new analysis, the maximum potential follow-up time was 29.3 years, and median follow-up was 23.6 years.

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By December 2017, 80% of the men enrolled in the study had died. The cumulative incidence of death from all causes at 23 years was 71.9% in the radical prostatectomy group and 83.8% in the watchful waiting group.

Seventy-one deaths in the radical prostatectomy group and 110 in the watchful waiting group were due to prostate cancer, for an absolute difference in risk of 11.7 percentage points.

Distant metastases were diagnosed in 92 men in the radical prostatectomy group and 150 men in the watchful waiting group. The study found that at 23 years the cumulative incidence of metastases was 26.6% in the radical prostatectomy group and 43.3% in the watchful waiting group.

The investigators found that among men in the radical prostatectomy group, an extracapsular extension was associated with a risk of death from prostate cancer that was five times that of men without extracapsular extension. In addition, a high Gleason score (>7) -- about 40% of both treatment groups had scored in that range -- was associated with a risk of death from prostate cancer that was 10 times higher than a score of 6 or lower.

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It may be noted that in both older and younger men, death from other causes without evidence of metastases or the use of androgen-deprivation therapy was more common in the radical-prostatectomy group than in the watchful-waiting group.

“Extended follow-up 23 years after the initiation of the study corroborated a substantial reduction in the rate of death after radical prostatectomy. The number needed to treat to prevent one death has continued to decrease,” write the authors.

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https://www.nejm.org/doi/full/10.1056/NEJMoa1311593