Radical prostatectomy versus observation for localized prostate cancer.
Timothy J Wilt,Michael K. Brawer,Karen M. Jones,Michael J. Barry,William J. Aronson,Steven Fox,Jeffrey R. Gingrich,John T. Wei,Patricia Gilhooly,B. Mayer Grob,Imad Nsouli,Padmini Iyer,Ruben Cartagena,Glenn Snider,Claus G. Roehrborn,Roohollah Sharifi,William Blank,Parikshit Pandya,Gerald L. Andriole,Daniel J. Culkin,Thomas M. Wheeler +20 more
TLDR
Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.Abstract:
During the median follow-up of 10.0 years, 171 of 364 men (47.0%) assigned to radi cal prostatectomy died, as compared with 183 of 367 (49.9%) assigned to observation (hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.08; P = 0.22; absolute risk reduction, 2.9 percentage points). Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation (hazard ratio, 0.63; 95% CI, 0.36 to 1.09; P = 0.09; absolute risk reduction, 2.6 percentage points). The effect of treatment on all-cause and prostate-cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor. Radical prostatectomy was associated with reduced all-cause mortality among men with a PSA value greater than 10 ng per milliliter (P = 0.04 for interaction) and possibly among those with intermediate-risk or high-risk tumors (P = 0.07 for interaction). Adverse events within 30 days after surgery occurred in 21.4% of men, including one death. CONCLUSIONS Among men with localized prostate cancer detected during the early era of PSA test ing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up. Absolute differences were less than 3 percentage points. (Funded by the Department of Veterans Affairs Cooperative Studies Program and others; PIVOT ClinicalTrials .gov number, NCT00007644.)read more
Citations
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EAU–ESTRO–SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent
Nicolas Mottet,Joaquim Bellmunt,Michel Bolla,Erik Briers,Marcus G. Cumberbatch,Maria De Santis,Nicola Fossati,Tobias Gross,Ann Henry,Steven Joniau,Thomas B. Lam,Thomas B. Lam,Malcolm David Mason,Vsevolod Matveev,Paul C. Moldovan,Roderick C.N. van den Bergh,Thomas Van den Broeck,Henk G. van der Poel,Theo H. van der Kwast,Olivier Rouvière,Ivo G. Schoots,Thomas Wiegel,Philip Cornford +22 more
TL;DR: The 2016 EAU-STRO-IOG Prostate Cancer (PCa) Guidelines present updated information on the diagnosis, and treatment of clinically localised prostate cancer and reflect the multidisciplinary nature of PCa management.
Journal ArticleDOI
The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System.
Jonathan I. Epstein,Lars Egevad,Mahul B. Amin,Brett Delahunt,John R. Srigley,Peter A. Humphrey +5 more
TL;DR: The basis for a new grading system was proposed in 2013 by one of the authors and accepted by the World Health Organization for the 2016 edition of Pathology and Genetics: Tumours of the Urinary System and Male Genital Organs.
Journal ArticleDOI
Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement
TL;DR: The USPSTF recommends against PSA-based screening for prostate cancer (grade D recommendation), which applies to men in the general U.S. population, regardless of age.
Journal ArticleDOI
10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer
Freddie C. Hamdy,Jenny L Donovan,J. Athene Lane,Malcolm David Mason,Chris Metcalfe,Peter Holding,Michael Davis,Tim J Peters,Emma L Turner,Richard M. Martin,Jon Oxley,M.C. Robinson,John Staffurth,Eleanor I Walsh,Prasad Bollina,James W.F. Catto,Andrew Doble,Alan Doherty,David Gillatt,Roger Kockelbergh,Howard Kynaston,Alan Paul,Philip Powell,Stephen Prescott,Derek J. Rosario,Edward Rowe,David E. Neal,David E. Neal +27 more
TL;DR: At a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments.
Journal ArticleDOI
EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent—Update 2013
Axel Heidenreich,Patrick J. Bastian,Joaquim Bellmunt,Michel Bolla,Steven Joniau,Theodor van der Kwast,Malcolm David Mason,Vsevolod Matveev,Thomas Wiegel,Filiberto Zattoni,Nicolas Mottet +10 more
TL;DR: Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa, and watchful waiting is a treatment alternative to androgen-deprivation therapy (ADT), with equivalent oncologic efficacy.
References
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AJCC Cancer Staging Manual
Mahul B. Amin,Stephen B. Edge,Frederick L. Greene,David R. Byrd,Robert K. Brookland,Mary Kay Washington,Jeffrey E. Gershenwald,Carolyn C. Compton,Kenneth R. Hess,Daniel C. Sullivan,J. Milburn Jessup,James D. Brierley,Lauri E. Gaspar,Richard L. Schilsky,Charles M. Balch,David P. Winchester,Elliot A. Asare,Martin Madera,Donna M. Gress,Laura R. Meyer +19 more
TL;DR: Purposes and Principles of Cancer Staging and End-Results Reporting are explained.
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Quality of life and satisfaction with outcome among prostate-cancer survivors.
Martin G. Sanda,Rodney L. Dunn,Jeff M. Michalski,Howard M. Sandler,Laurel L. Northouse,Larry Hembroff,Xihong Lin,Thomas K. Greenfield,Mark S. Litwin,Mark S. Litwin,Christopher S. Saigal,Arul Mahadevan,Eric A. Klein,Adam S. Kibel,Louis L. Pisters,Deborah A. Kuban,Irving D. Kaplan,Darien Wood,Jay P. Ciezki,Nikhil L. Shah,John T. Wei +20 more
TL;DR: Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function, and these changes influenced satisfaction with treatment outcomes among patients and their spouses or partners.
Journal ArticleDOI
Radical prostatectomy versus watchful waiting in early prostate cancer.
Anna Bill-Axelson,Anna Bill-Axelson,Lars Holmberg,Mirja Ruutu,Hans Garmo,Jennifer R. Stark,Jennifer R. Stark,Christer Busch,Stig Nordling,Michael Häggman,Swen-Olof Andersson,Stefan Bratell,Anders Spångberg,Juni Palmgren,Gunnar Steineck,Hans-Olov Adami,Hans-Olov Adami,Jan-Erik Johansson +17 more
TL;DR: Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer, and men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment.
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