Radical Prostatectomy Versus Observation for Localized Prostate Cancer

Is surgery superior to watchful waiting for patients with localized prostate cancer? To answer this question, the investigators performed a randomized trial in men associated with the Veterans Affairs hospital system. They compared 364 men who received radical prostatectomy with 367 men who were observed. Patients who were included in the trial had prostate-specific antigen (PSA) levels < 50 ng/mL, were younger than 75 years of age, and were free of metastatic disease. During a median follow-up of 10 years, mortality rate was 47% in operated patients and 49.9% in nonoperated patients (P = .22).

Similar outcomes were observed in analysis of several subgroups of patients. About 20% of operated patients had an adverse event within the first month.

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The results of this trial support observation as a valid alternative to radical surgery for men with localized prostate cancer and PSA levels in the lower range. Overall, 7% of all patients died of prostate cancer. Prostate cancer deaths were responsible for only 15% of total deaths in the observation group. This study provides much needed information to help physicians, as well as patients with early prostate cancer, decide about treatment options.