Similar prostate cancer and all-cause mortality in men with localised prostate cancer undergoing surgery or radiation therapy versus active monitoring at 10 years of follow-up.

Commentary on : Hamdy FC , Donovan JL , Lane JA , et al . 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375:1415–24.[OpenUrl][1] Donovan JL, Hamdy FC, Lane JA, et al . Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2016;375:1425–37. Prostate cancer (PCA) remains a common and potentially fatal condition. Effective and safe treatment options are needed. However, few randomised trials have assessed the benefits and harms of radical prostatectomy (RPX), radiation therapy (XRT) and watchful waiting/observation to provide the evidence base for treating men with clinically localised PCA. The Scandinavian Prostate Cancer Group-4 (SPCG-4) trial randomised 695 men diagnosed in the pre-prostate-specific antigen (PSA) era, most had palpable disease, to surgery or observation.1 After a median follow-up of 13.4 years, surgery reduced PCA deaths by 44% (HR=0.56; 95% CI 0.41 to 0.77; absolute risk reduction=11 percentage points). All-cause mortality was reduced by 12.7 percentage points. Reductions were confined to men <65 years of age. The Prostate Cancer Intervention Versus Observation Trial (PIVOT) randomised 731 men from the early PSA era to RPX or observation.2 After a 10-year median follow-up, surgery did not reduce disease-specific mortality (HR=0.63; 95% CI 0.36 to 1.09). There was also no significant reduction for all-cause mortality. Absolute differences were 10 ng/mL or intermediate risk disease (p for interaction=0.11 for PCA mortality in both subgroups). The Prostate Testing … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D375%26rft.spage%253D1415%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx