Radical Prostatectomy versus Observation for Localized Prostate Cancer

SUMMARY: In this study, 731 men with localized prostate cancer, diagnosed based on PSA testing, were randomly assigned to Radical Prostatectomy (RP) or Observation. The median age was 67 years, median PSA was 7.8ng/ml and median follow up was 10 years. This study concluded that RP did not significantly reduce all cause mortality or mortality related to prostate cancer. However on subset analysis, RP slightly decreased mortality among men with PSA greater than 10ng/ml and among those with intermediate and high D’Amico tumor risk score. As only 10% of the patients were less than 60 years of age, these data may not be applicable to this patient subset. Based on this study, it may be reasonable to avoid RP for those prostate cancer patients with PSA levels of 10ng/ml or less and for those with low risk tumors. Wilt TJ, Brawer MK, Jones KM, et al., for the Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group. N Engl J Med 2012; 367:203-213