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This is conclusive proof that treatment markedly reduces the risk of death due to prostate cancer.
Men assigned to radical prostatectomy also had significantly lower relative risks of distant metastases than men assigned to watchful waiting.
However, treatment strategies cannot be assumed to convey benefit and must be subjected to sophisticated clinical trials that take into account the variable risk profiles of patients.
Canadian physicians and their patients should be aware that the Scandinavian Prostatic Cancer Group has just reported a landmark randomized trial comparing radical prostatectomy and watchful waiting in early prostate cancer (see In the Literature page 67).67 Over 10 years, almost 700 men with newly diagnosed prostate cancer that was either clinically inapparent, confined to the prostate or diagnosed by needle biopsy performed because of an elevated prostate-specific antigen (PSA) level and whose tumours were graded as well or moderately well differentiated were randomly allocated to receive a radical prostatectomy or watchful waiting.
Prostate cancer is frequently diagnosed in elderly men with competing causes of mortality and often grows very slowly.2 The natural history of prostate cancer makes treatment decisions difficult and complicates the design and interpretation of clinical trials.
There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue.This year, about 90,000 men will undergo radical prostatectomy, a procedure in which the entire prostate is removed.They face common side effects such as impotence and incontinence during routine activities, and urologists have recently learned that some may also leak urine during sex."We overlook some of the other issues that are relevant to overall sexual function," added Lepor, who led the new study.Lepor's team looked at responses to questionnaires from 1,459 men who had undergone radical prostatectomy at NYU's Langone Medical Center between 20.
After a median 6.2 years of follow-up, death due to prostate cancer occurred in 4.6% of those assigned to radical prostatectomy and in 8.9% of those assigned to watchful waiting (relative risk 0.50, 95% confidence interval 0.27–0.91).