Commentary Journal Watch| Volume 80, ISSUE 6, P1181-1182, December 2012

Commentary on: Radical Prostatectomy Versus Observation for Localized Prostate Cancer

Published:October 04, 2012DOI:
      The Prostate Cancer Intervention Versus Observation Trial (PIVOT) randomized 731 men with clinically organ-confined (T1-T2) prostate cancer to observation versus radical prostatectomy. The patients had to be <75 years old and have a prostate-specific antigen (PSA) <50 ng/mL, but no restrictions were used for Gleason score. The main finding of the study was that neither the all-cause mortality nor the prostate-cancer mortality differed between groups after a median follow-up of 10 years. The absolute reduction in risk of death from all causes was 2.9% with radical prostatectomy and the relative risk reduction was 12%; however, this was not statistically significant (95% confidence interval 0.71-1.08, P = .22). The absolute risk reduction for prostate cancer mortality was similar (2.6%). Although the relative risk reduction for prostate cancer mortality was more pronounced at 37%, the difference was again not statistically significant (95% confidence interval 0.36-1.09, P = .09). The rate of bone metastasis declined from 10.6% to 4.7% with radical prostatectomy, for a relative risk reduction of 60% (95% confidence interval 0.22-0.70, P < .001).
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