Could Prostatectomy Improve Mortality Outcomes with Localized Prostate Cancer?

Adverse events occurred more frequently among men who received surgery for localized prostate cancer than those who underwent observation, according to the findings of a recent study. The researchers also found no significant decreases in mortality between men who were observed and those who underwent surgery.

The study included 731 men with localized prostate cancer who were randomly assigned to undergo radical prostatectomy or observation, and were followed for 19.5 years. All-cause mortality was assessed as the primary outcomes, and prostate cancer-related mortality was assessed as the secondary outcome.
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Overall, 223 of the 364 men assigned to surgery (61.3%) and 245 (66.8%) of the 367 men assigned to observation died over the course of the study.

Death associated with prostate cancer or treatment occurred in 27 men (7.4%) who underwent surgery and in 42 men (11.4%) who were observed. While surgery was associated with lower all-cause mortality among men with intermediate-risk disease, it did not decrease the risk of all-cause mortality among men with low or high disease risks.

In addition, the researchers found that treatment for disease progression occurred less frequently among men who underwent surgery than those who underwent observation, and was primarily for asymptomatic, local, or prostate-specific antigen progression.

Patients who underwent surgery were more likely to experience urinary incontinence and erectile and sexual dysfunction compared with those who were observed through 10 years. Likewise, surgery was associated with more disease-related and treatment-related limitations in daily activities through 2 years compared with observation.

“After nearly 20 years of follow-up among men with localized prostate cancer, surgery was not associated with significantly lower all-cause or prostate-cancer mortality than observation,” the researchers concluded. “Surgery was associated with a higher frequency of adverse events than observation but a lower frequency of treatment for disease progression, mostly for asymptomatic, local, or biochemical progression.”

—Melissa Weiss

Reference:

Wilt TJ, Jones KM, Carry MJ, et al. Follow-up of prostatectomy versus observation for early prostate cancer [published online July 13, 2017]. N Engl J Med. doi:10.1056/NEJMoa1615869.