Radical prostatectomy (RP) may provide small very long-term reductions in death risk compared with observation for patients with clinically localized prostate cancer (PCa), according to investigators.

In an extended follow-up of 731 participants in the randomized Prostate Cancer Intervention versus Observation Trial (PIVOT), men assigned to undergo RP had an 8% reduction in the relative risk of death and mean survival increase of 1 year compared with those assigned to undergo observation, Timothy J. Wilt, MD, of the Minneapolis VA Center for Care Delivery and Outcomes Research in Minneapolis, and colleagues reported in European Urology.

“Absolute effects did not vary markedly by patient characteristics,” the investigators wrote. “Absolute effects and mean survival were much smaller in men with low-risk disease, but were greater in men with intermediate-risk disease although not in men with high-risk disease.”

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The study enrolled men aged 75 years or less with localized PCa, PSA level below 50 ng/mL, a life expectancy of 10 years or more, and were medical fit for surgery. Increasing CAPRA scores were associated with increased death risk in the surgery and observation arms.

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Of the 731 men, 515 died. The minimum and maximum follow-up for the 216 survivors was 15.0 and 22.1 years, respectively. The median follow-up was 18.6 years.

“While our results suggest that results did not vary by most tumor or patient characteristics, we found numerically greater effects due to surgery in selected subgroups: younger and healthier men, those with intermediate-risk disease based on either D’Amico or CAPRA categorization, and individuals with higher percentage of cancer-positive biopsy cores,” Dr Wilt and his collaborators wrote.


Wilt TJ, Vo TN, Langsetmo L, et al. Radical prostatectomy or observation for clinically localized prostate cancer: Extended follow-up of the Prostate Cancer Intervention versus Observation Trial (PIVOT) [published online February 20, 2020]. Eur Urol. doi: 10.1016/j.eururo.2020.02.009