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As a consequence of testing for prostate-specific antigen (PSA), over 130 000 American men are diagnosed with prostate cancer each year. A significant majority of these men harbour localised disease. The recent update of the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) by Bill-Axelson and colleagues provides significant new data that carry important practical implications for contemporary practice.
The SPCG-4 was initiated in the 1980s to determine the relative efficacy of radical prostatectomy versus watchful waiting to improve all-cause survival and prostate cancer-specific survival in men with newly diagnosed, localised disease. Between 1989 and 1999 a total of 695 men were randomised to undergo either a radical prostatectomy (n=347) or watchful waiting (n=348). All men received antiandrogen therapy with the onset of disease progression. Men had to …
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