Randomized controlled trial of radical prostatectomy vs. watchful waiting

The Scandinavian trial that compared surgery to no surgery is one of the very few randomized clinical trial of treatment of prostate cancer. It is level 1 evidence that show that surgery can work, but it's not as effective as you might think. I saw that the article and the graphs from the most recent report of this study, with 12 years of followup, is now posted for free on the pubmed website. It's worth looking at these.

There is a recent thread here about longevity with prostate cancer. This is the best article I've seen to answer that, because if you ask the question, "will surgery help me to live longer", the next question is "compared to what?". The answer that you want to this second question is, "compared to those who didn't have surgery". This study gives some of the answers to these questions. It was helpful to me when I was deciding on whether to get treated:

The link to the charts:

www.ncbi.nlm.nih.gov/images?term=18695132[PMID]

The article:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2518167


Especially look at Figure 3. In this patient group, surgery increased survival if it was done on men younger than 65. When it was done on older men, there was no difference in survival between surgery and watchful waiting.

Numbers don't mean anything to me. I'm only interested in my own survival and have chosen to get rid of the cancer as soon and as completely as possible. As a result, I have piece of mind that I have done everything possible to stay in remission.

I did this for prostate cancer for my own peace of mind. I watched my dad die from stage IV PCa. It took 18 months and was a heartbreaking ordeal that I wanted to avoid at all costs.

By having surgery for lung cancer followed by chemo I raised my chances of living 5 years from 0% to 65%. Once again I am at peace with my decisions.

Early detection followed by aggressive treatment are the best ways to battle cancer, in my humble opinion.

Jim

Yeah, that figure (#2) shows that surgery greatly cuts down your chances of having local progression or needing hormonal therapy. If you compare the chances of dying from prostate cancer, the differences aren't so great. If you have growing prostate cancer, it causes all kinds of problems, even if you don't end up dying from it. That's an argument for getting treated.

Also, this study has limitations, especially that most of these patients had their cancer found by rectal exam and symptoms, not by PSA. Also treatment has hopefully gotten better over the years, although that could help both the surgery and the watchful waiting groups to live longer.

Post Edited (Postop) : 3/26/2011 9:51:56 AM (GMT-6)

I wouldn't say that! This is a randomized study, where patients are randomized between surgery and no surgery. This is level 1 evidence, which is the gold standard for proving that a treatment works! There are thousands and thousand of prostate cancer studies done without a control group. If you ask the question of whether the treatment you are getting is actually making a difference for you, you need to know what will happen if you don't get the treatment. That means a control group. Also, how the control group is picked is important. If the doctor decides to operate on the worse cases, and watch the mild ones, that kind of control group is meaningless. The only way to have a meaningful control group is to randomize the men between treatment and no treatment. You can image how hard it must be for someone to agree to be randomized between surgery and no surgery. That's why this is the only level 1 study of surgery for prostate cancer. It is a unique piece of information.

Studies of prostate cancer studies without a control group may claim that a particular treatment works, but can't answer the question, "does it work better than not treating?" Since prostate cancer is so slow growing, that's an important question. Treating prostate cancer with surgery or radiation does nothing to increase lifespan in an 80 year old person with severe heart disease, for example. When I was deciding whether to get treated, my question was, "how much better off would I be getting treated than if I didn't do it?" Everyone deciding on treatment for prostate cancer needs to ask that question.

Also, you are incorrect to say that these patients are not classified according to the severity of their disease. There are exhaustive data in this paper on this, as well as other papers on this study (some which can be accessed from the article in the link) on this, including PSA and stage at the time of diagnosis.

The younger you are, the more benefit surgery offers..This is no revelation. I was 68 when I had surgery. My surgeon seldom operated on men over 70. I asked why? He responded "The surgical risk gets to high and the benefit becomes less..When you are older than 70, other forms of treatment do just as well if not better"..

Something about your projected lifespan and your cancer mortality coming together at the same point...

I have spent most of the morning looking at this study and following various links. John T, Worried Guy and Postop all make real good points. I’d like to see what kind of take Casey has on it. I have several questions that I’ll get answered Monday. Those darn Scandinavians..