{"id":309,"date":"2014-03-28T23:25:17","date_gmt":"2014-03-28T23:25:17","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=309"},"modified":"2017-08-21T12:55:26","modified_gmt":"2017-08-21T12:55:26","slug":"primary-care-corner-with-geoffrey-modest-md-radical-prostatectomy-for-prostate-cancer","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/03\/28\/primary-care-corner-with-geoffrey-modest-md-radical-prostatectomy-for-prostate-cancer\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Radical prostatectomy for prostate cancer"},"content":{"rendered":"
\n
the\u00a0<\/span>Scandinavian<\/span>\u00a0prostate cancer group study published their 18 year followup of radical prostatectomy vs watchful waiting in men with localized prostate cancer (study prior to PSA testing, and was largely of men with palpable nodules).\u00a0<\/span>see<\/span>\u00a0<\/b><\/span>DOI<\/span>: 10.1056\/<\/span><\/strong>NEJMoa1311593<\/strong>. this follows their 15 year followup published a couple of years ago. in brief,<\/span><\/div>\n
<\/div>\n
–695 men with early prostate cancer randomized to surgery vs watchful waiting, followed up to\u00a0<\/span>23.2 years, though overall analysis at 18 year mark:\u00a0<\/span><\/div>\n
—<\/span>63 deaths from prostate cancer in surgery group and 99 in watchful waiting (18% vs 29%, RR 0.56), absolute diff of 11% and NNT to prevent one death = 8<\/span><\/div>\n
–200 deaths from all causes in the surgery group and 247 in the watchful waiting group (56.1% vs 68.9%, RR 0.71, abs diff 12.8%)<\/span><\/div>\n
–androgen-deprivation therapy in fewer pts in surgery group vs\u00a0<\/span>watchful waiting<\/span>, (42.5 vs 67.4%, abs diff 25%)<\/span><\/div>\n
–benefit of surgery largest in men younger than 65 and those with intermediate-risk prostate cancer (eg gleason score <8), though also reduced risk of metastases in older men.<\/span><\/div>\n
–both death from any cause and death from prostate cancer were significantly lower in those <65yo (RR 0.50, abs risk reduction ARR 25.5% for death from any cause; and RR 0.45, ARR 15.8% for prostate ca deaths. both NS for those >=65yo). \u00a0distant mets with RR 0.49 and ARR 15.8% in <65yo and RR 0.75 and ARR 6.6% if >=65yo.<\/span><\/div>\n
–no evidence that effect diminished over time<\/span><\/div>\n
<\/div>\n
so, my general assessment of this update is not really different from the last one. will append my blog from 7\/26\/2012 below on the PIVOT study with comments on Scandanavian one. of course, one major concern with the scandanavian study is that about 90% of the men were randomized after prostate cancer detected on rectal exam (which has worse prognosis than picking up with PSA), so current applicability a bit murky).<\/span><\/div>\n
<\/div>\n
<\/div>\n<\/div>\n
\n
geoff<\/span><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Radical prostatectomy for prostate cancer […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-309","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/309","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=309"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/309\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=309"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=309"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=309"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}