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Randomised controlled trial
Radical prostatectomy reduces prostate cancer-specific mortality among men with intermediate-grade disease, but provides minimal benefit for men with low-grade and high-grade disease
  1. Peter Albertsen
  1. Department of Surgery (Urology), University of Connecticut Health Center, Farmington, Connecticut, USA
  1. Correspondence to: Professor Peter Albertsen, Department of Surgery (Urology), University of Connecticut Health Center, MC 3955, 263 Farmington Avenue, Farmington, CT 06030, USA; albertsen{at}

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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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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.