In an updated study published in the New England Journal of Medicine men who had a radical prostatectomy did not enjoy the experience of a reduced all-cause mortality or prostate cancer mortality compared with those men who had only observation through several years of follow-up. The subject men had localized prostate cancer often detected by prostate-specific antigen (PSA) testing.

The study evaluated a total of 731 men (mean age, 67 years) who had localized prostate cancer (median PSA value, 7.8 ng per milliliter). The men were randomized to radical prostatectomy or to observation from November 1994 through January 2002, and were followed through January 2010. During the median follow-up of 10 years, 171 of 364 men (47%) assigned to radical prostatectomy died, compared with 183 of 367 men (49.9%) in the observation group.

Adverse events within 30 days after surgery, including one death, occurred in 21.4% of patients.

In the radical prostatectomy group, 21 men (5.8%) died from prostate cancer or treatment, compared with 31 men (8.4%) assigned to observation.

The study showed that the effect of treatment on all-cause and prostate cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor, but radical prostatectomy was associated with reduced all-cause mortality among men with a PSA value greater than 10 ng per milliliter, and possibly among men with intermediate-risk or high-risk tumors.

(N Engl J Med. 2012;367:203-213)

Joel T. Nowak, M.A., M.S.W.