Radical Prostatectomy Versus Observation for Localized Prostate Cancer

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0007 ◽

2021 ◽

pp. 37-42

Author(s):

Philipp Dahm

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Watchful Waiting ◽

Specific Antigen ◽

Localized Prostate Cancer ◽

Disease Specific Survival ◽

Long Term Follow Up ◽

Disease Specific

This chapter provides a summary of the landmark PIVOT trial that randomized men with clinically localized prostate cancer from the early prostate-specific antigen (PSA) era to radical prostatectomy versus watchful waiting. Based on long-term follow-up, the study found that surgery provided only small reductions in disease-specific survival but caused substantial side effects. It suggested that many men with clinically localized prostate cancer fare well with watchful waiting.

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Radical Prostatectomy Versus Observation in Early Prostate Cancer

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0006 ◽

2021 ◽

pp. 31-36

Author(s):

Philipp Dahm

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Cancer Mortality ◽

Watchful Waiting ◽

Specific Antigen ◽

Prostate Cancer Mortality ◽

Cancer Group

This chapter provides a summary of the landmark Scandinavian Prostate Cancer Group Study Number 4 trial of men with clinically localized prostate cancer from the pre–prostate-specific antigen (PSA) era who were randomized to radical prostatectomy versus watchful waiting and were followed long term. With follow-up of more than 20 years, the results favored surgery with regard to prostate cancer mortality.

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Long-Term Clinical Outcomes of Radical Prostatectomy versus Watchful Waiting in Localized Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Iranian Journal of Public Health ◽

10.18502/ijph.v48i4.978 ◽

2019 ◽

Author(s):

Mojtaba NOUHI ◽

Seyed Masood MOUSAVI ◽

Alireza OLYAEEMANESH ◽

Nasser SHAKSISALIM ◽

Ali AKBARI SARI

Keyword(s):

Prostate Cancer ◽

Urinary Incontinence ◽

Radical Prostatectomy ◽

Clinical Outcomes ◽

Watchful Waiting ◽

Localized Prostate Cancer ◽

Controlled Trials ◽

All Cause Mortality

Background: The present study aimed to compare the long-term clinical and functional outcomes of patients with clinically localized prostate cancer treated with radical prostatectomy compared to the watchful waiting. Methods: PubMed, Cochrane Central Register of Controlled Trials and reference lists of relevant marker studies were scrutinized from inception to Jan 2018. Two reviewers conducted data abstraction and quality assessment of included trials independently. Quality of included studies were assessed by using Cochrane checklist. Inverse-variance and Mantel-Haenszel estimates under random effects model were used to pool results as relative risks with 95% confidence interval. Heterogeneity was assessed by using I2. Results: Three randomized controlled trials with 1568 participants were included. Compared to watchful waiting, radical prostatectomy had no significant effect on all-cause mortality at 12-year follow-up. However, radical prostatectomy had significant effect on reducing prostate-cause mortality at 12-year follow-up. We found significant lower prostate-cause mortality in patients with PSA>10 and GS≥7 scores who had undergone radical prostatectomy compared with patients in watchful waiting group. In addition, younger patients undergoing surgery developed lower distant metastases rate compared to another approach. Watchful waiting had a significant effect on erectile and urinary incontinence during 2 years. Conclusion: There was no significant difference between radical prostatectomy and watchful waiting on all-cause mortality. However, the radical prostatectomy was associated with statistically lower prostate-cause mortality and metastases rates. Compared with older men, younger men experienced better clinical outcomes. Moreover, watchful waiting had better effect on reducing erectile dysfunction and urinary incontinence among patients during 2 years compared to radical prostatectomy.

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