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Prognosis
Minimal difference in survival between radical prostatectomy and observation in men with modest life expectancy
  1. Vignesh T. Packiam,
  2. Scott E. Eggener
  1. Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr. Vignesh T. Packiam, Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL 60637, USA; vignesh.packiam{at}uchospitals.edu

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Commentary on: Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 2017;377:132–42.

Context

Screening, diagnosis and management of localised prostate cancer remains controversial.

Methods

Prostate Cancer Intervention Versus Observation Trial (PIVOT) was a randomised controlled trial that accrued 731 men with prostate cancer (PCa) between 1994 and 2002 from Veterans Affairs hospitals. Patients were randomised to radical prostatectomy (n=364) or observation (n=367). Inclusion criteria was clinical stage T1–T2 (organ confined), prostate-specific antigen (PSA) <50 ng/mL, age ≤75 years and estimated life expectancy >10 years. Primary and secondary outcomes were all-cause and prostate-cancer mortality.

Findings

Median age was 67 years, median PSA 7.8 ng/mL and 45% of patients were clinical stage T2 (palpable on exam). After 19.5 years follow-up (median 12.7 years), cumulative all-cause mortality was similar between surgery and observation (61.3% vs 66.8%; HR 0.84; 95% CI 0.70 …

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