Radical prostatectomy (RP) for prostate cancer (PCa) is difficult to justify for patients with Gleason 6, T1 disease, researchers concluded.

These patients have a relatively low risk of cancer-related death and metastasis. “Such patients would appear appropriate for an active surveillance program, with curative treatment considered for state or grade progression,” they reported online ahead of print in European Urology.

Andrew Vickers, MD, of Memorial Sloan-Kettering Cancer Center in New York, and colleagues analyzed data from 695 men with T1 or T1 PCa who participated in the Scandanavian Prostate Cancer Group 4 trial. At age 65, the 10-year predicted cumulative incidence of PCa mortality associated with RP (versus watchful waiting) was 4% among men with Gleason 6, T1 disease. The 10-year predicted cumulative incidence of metastasis was 6%.

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Little expected benefit was associated with surgery much beyond age 70, the investigators noted.

“Our findings can be used to counsel individual patients who are considering treatment options for localized prostate cancer,” the authors noted.