20 Year Follow-Up of Surgery vs Active Surveillance for Early Prostate Cancer

MedicalResearch.com Interview with:
Dr. Timothy Wilt, MD MPH

Core Investigator: Minneapolis VA Center for Chronic Disease Outcomes Research
Staff Physician: Section of General Internal Medicine, Minneapolis VA Health Care System
Professor: Medicine, University of Minnesota School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prostate cancer is common and potentially serious. However, the comparative benefits and harms of surgery versus observation in men with localized prostate cancer are not known.

After nearly 20 years, surgery did not significantly reduce all-cause or prostate cancer mortality compared to observation, particularly in men with low risk disease. Surgery was associated with more harms than observation, causing complications within 30 days in about 20% of men and large long term increases in urinary incontinence, sexual dysfunction and dissatisfaction, as well as treatment related bother and reductions in daily functioning.

MedicalResearch.com: What are the main findings?

Response: Surgery reduced subsequent treatment for disease progression but most was for asymptomatic and PSA progression for which the clinical benefits are not certain. Our study is the largest and longest study comparing surgery to observation in men with mostly PSA detected localized prostate cancer; and it was conducted in the US so findings can inform clinical decision making for many individuals.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: For most men with localized prostate cancer, especially men with low risk/low PSA disease, older men, or men with coexisting medical conditions, observation is a wise and preferred treatment choice.

Observation results in a very low and similar risk of prostate cancer death, a similar overall survival, and avoids treatment harms.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Methods are needed to disseminate and implement these findings into shared decision making steps and to promote practice guideline and policy reform to improve health care quality by reducing overdiagnosis and overtreatment.  For younger men with higher risk disease, safer and more effective treatments are needed.

MedicalResearch.com: Is there anything else you would like to add?

Response: Physicians now have convincing scientific evidence from multiple large, long-term randomized trials demonstrating that they can now confidently recommend observation and/or PSA based active monitoring as the preferred treatment choice for most men with localized PSA detected prostate cancer. Prostate cancer mortality is rare for men with low risk disease when treated with observation and any possible differences in very long term mortality that might exist for men with higher risk disease may not outweigh treatment related harms.

No disclosures.

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Follow-up of Prostatectomy versus Observation for Early Prostate Cancer

Timothy J. Wilt, M.D., M.P.H., Karen M. Jones, M.S., Michael J. Barry, M.D., Gerald L. Andriole, M.D., Daniel Culkin, M.D., Thomas Wheeler, M.D., William J. Aronson, M.D., and Michael K. Brawer, M.D.

N Engl J Med 2017; 377:132-142July 13, 2017DOI: 10.1056/NEJMoa161586

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Last Updated on July 13, 2017 by Marie Benz MD FAAD