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Radical Prostatectomy or Watchful Waiting in Prostate Cancer-29-Year Follow-up

Artikel i vetenskaplig tidskrift
Författare A. Bill-Axelson
L. Holmberg
H. Garmo
K. Taari
C. Busch
S. Nordling
M. Haggman
S. O. Andersson
O. Andren
Gunnar Steineck
H. O. Adami
J. E. Johansson
Publicerad i New England Journal of Medicine
Volym 379
Nummer/häfte 24
Sidor 2319-2329
ISSN 0028-4793
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för onkologi
Sidor 2319-2329
Språk en
Länkar dx.doi.org/10.1056/NEJMoa1807801
Ämnesord cancer, General & Internal Medicine
Ämneskategorier Cancer och onkologi

Sammanfattning

BACKGROUND Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term followup is sparse. METHODS We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model. RESULTS By December 31, 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died; 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to prostate cancer (relative risk, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001; absolute difference in risk, 11.7 percentage points; 95% CI, 5.2 to 18.2). The number needed to treat to avert one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life were gained with radical prostatectomy. Among the men who underwent radical prostatectomy, extracapsular extension was associated with a risk of death from prostate cancer that was 5 times as high as that among men without extracapsular extension, and a Gleason score higher than 7 was associated with a risk that was 10 times as high as that with a score of 6 or lower (scores range from 2 to 10, with higher scores indicating more aggressive cancer). CONCLUSIONS Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer.

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