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Radical Prostatecto...
Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer
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- Bill-Axelson, Anna (författare)
- Uppsala universitet,Urologkirurgi,University of Uppsala Hospital, Sweden
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- Holmberg, Lars (författare)
- Uppsala universitet,Endokrinkirurgi,Regional Cancer Center Uppsala Örebro,University of Uppsala Hospital, Sweden Kings Coll London, England
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- Garmo, Hans (författare)
- University of Uppsala Hospital, Sweden Kings Coll London, England,Reg Canc Ctr Uppsala Orebro, Univ Uppsala Hosp, Uppsala, Sweden; Sch Med, Div Canc Studies, Kings Coll London, London , England,Regional Cancer Center Uppsala Örebro
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- Rider, Jennifer R. (författare)
- Brigham and Womens Hospital, MA USA Harvard University, MA USA Harvard University, MA 02115 USA,Dept Med, Channing Lab, Brigham & Womens Hosp, Boston MA, USA; Sch Med, Harvard Univ, Boston MA, USA; Sch Publ Hlth, Dept Epidemiol, Harvard Univ, Boston MA, USA
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- Taari, Kimmo (författare)
- University of Helsinki, Finland,Cent Hosp, Dept Urol, Univ Helsinki, Helsinki, Finland
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- Busch, Christer (författare)
- Uppsala universitet,Institutionen för immunologi, genetik och patologi,University of Uppsala Hospital, Sweden
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- Nordling, Stig (författare)
- University of Helsinki, Finland,Dept Pathol, Univ Helsinki, Helsinki, Finland
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- Häggman, Michael (författare)
- Uppsala universitet,Urologkirurgi,University of Uppsala Hospital, Sweden
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- Andersson, Swen-Olof, 1949- (författare)
- Örebro universitet,Institutionen för hälsovetenskap och medicin,Region Örebro län,Dept Urol, Örebro University Hospital, Örebro, Sweden,University of Örebro, Sweden Örebro University Hospital, Sweden
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- Spångberg, Anders (författare)
- Östergötlands Läns Landsting,Linköpings universitet,Avdelningen för kliniska vetenskaper,Hälsouniversitetet,Urologiska kliniken i Östergötland,Dept Urol, Linköping, Linköping Univ Hosp, Linköping, Sweden
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- Andrén, Ove, 1963- (författare)
- Örebro universitet,Institutionen för hälsovetenskap och medicin,Region Örebro län,Dept Urol, Örebro University Hospital, Örebro, Sweden,University of Örebro, Sweden Örebro University Hospital, Sweden
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- Palmgren, Juni (författare)
- Karolinska Institutet,Karolinska Institute, Sweden
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- Steineck, Gunnar, 1952 (författare)
- Karolinska Institutet,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,Karolinska Institute, Sweden Sahlgrens Acad, Sweden
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- Adami, Hans-Olov (författare)
- Karolinska Institutet,Karolinska Institute, Sweden Harvard University, MA 02115 USA
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- Johansson, Jan-Erik, 1946- (författare)
- Örebro universitet,Institutionen för hälsovetenskap och medicin,Region Örebro län,Dept Urol, Örebro University Hospital, Örebro, Sweden,University of Örebro, Sweden Örebro University Hospital, Sweden
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(creator_code:org_t)
- Waltham : Massachusetts Medical Society, 2014
- 2014
- Engelska.
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Ingår i: New England Journal of Medicine. - Waltham : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 370:10, s. 932-942
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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https://gup.ub.gu.se...
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http://kipublication...
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- BackgroundRadical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. MethodsBetween 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. ResultsDuring 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04). ConclusionsExtended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.) The randomized Swedish trial of prostatectomy versus watchful waiting in disease detected mainly clinically (not by PSA screening) continues to show a benefit for early prostatectomy. The number of men younger than 65 needed to treat to prevent one death is now four. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of prostate-specific antigen (PSA) testing, showed a survival benefit of radical prostatectomy as compared with observation at 15 years of follow-up.(1) By contrast, the Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of PSA testing, showed that radical prostatectomy did not significantly reduce prostate cancer-specific or overall mortality after 12 years.(2) PSA screening profoundly changes the clinical domain of study. Among other considerations, the substantial additional lead time ...
Ämnesord
- 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 -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Allmänmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- General Practice (hsv//eng)
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- MEDICINE
- MEDICIN
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Bill-Axelson, An ...
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Holmberg, Lars
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Garmo, Hans
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Rider, Jennifer ...
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Taari, Kimmo
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Busch, Christer
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Nordling, Stig
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Häggman, Michael
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Andersson, Swen- ...
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Spångberg, Ander ...
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Andrén, Ove, 196 ...
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Palmgren, Juni
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Steineck, Gunnar ...
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Adami, Hans-Olov
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Johansson, Jan-E ...
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Linköpings universitet
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Örebro universitet
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Göteborgs universitet
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Karolinska Institutet
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Uppsala universitet