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Sökning: onr:"swepub:oai:DiVA.org:uu-372932" > Radical Prostatecto...

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

Bill-Axelson, Anna, (författare)
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
Holmberg, Lars, (författare)
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; School of Medicine, Division of Cancer Studies, Sweden hSchool of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
Garmo, Hans, (författare)
Regional Cancer Center Uppsala, Uppsala University Hospital, Uppsala, Sweden; School of Medicine, Division of Cancer Studies, Sweden, London, United Kingdom
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Taari, Kimmo, (författare)
Department of Urology, Helsinki University Hospital, Helsinki, Finland.
Busch, Christer, (författare)
Uppsala University Hospital, Department of Pathology, Uppsala, Sweden
Nordling, Stig, (författare)
Department of Pathology, University of Helsinki, Helsinki, Finland
Häggman, Michael, (författare)
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
Andersson, Swen-Olof, (författare)
Department of Urology, Örebro University Hospital, Örebro, Sweden
Andrén, Ove, 1963- (författare)
Örebro universitet, Institutionen för medicinska vetenskaper, Department of Urology
Steineck, Gunnar, (författare)
Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Gothenburg, Sweden
Adami, Hans-Olov, (författare)
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T.C. Chan School of Public Health, Boston, United States; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
Johansson, Jan-Erik, (författare)
Department of Urology, Örebro University Hospital, Örebro, Sweden
Andren, Ove, (författare)
Orebro Univ, Sch Hlth & Med Sci, Orebro, Sweden;Orebro Univ Hosp, Dept Urol, Orebro, Sweden
Haggman, M. (författare)
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Örebro universitet Institutionen för medicinska vetenskaper. (creator_code:org_t)
Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska fakulteten. Institutionen för kirurgiska vetenskaper. Urologkirurgi. (creator_code:org_t)
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Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska fakulteten. Institutionen för kirurgiska vetenskaper. Endokrinkirurgi. (creator_code:org_t)
Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm. Uppsala kliniska forskningscentrum (UCR). (creator_code:org_t)
Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska fakulteten. Institutionen för immunologi, genetik och patologi. (creator_code:org_t)
Göteborgs universitet Sahlgrenska akademin. Institutionen för kliniska vetenskaper, Avdelningen för onkologi. 
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2018
Engelska.
Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 379:24, s. 2319-2329
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Allmän medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Family Medicine (hsv//eng)

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cancer
General & Internal Medicine

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