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Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: the Scandinavian Prostate Cancer Group-4 Randomized Trial

Bill-Axelson, Anna ; Holmberg, Lars ; Filén, Frej ; Ruutu, Mirja ; Garmo, Hans ; Busch, Christer ; Nordling, Stig ; Häggman, Michael ; Andersson, Swen-Olof ; Bratell, Stefan ; Spångberg, Anders ; Palmgren, Juni ; Adami, Hans-Olov ; Johansson, Jan-Erik

JNCI : Journal of the National Cancer Institute, 2008-08, Vol.100 (16), p.1144-1154 [Periódico revisado por pares]

Cary, NC: Oxford University Press

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Título:
Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: the Scandinavian Prostate Cancer Group-4 Randomized Trial
Autor: Bill-Axelson, Anna ; Holmberg, Lars ; Filén, Frej ; Ruutu, Mirja ; Garmo, Hans ; Busch, Christer ; Nordling, Stig ; Häggman, Michael ; Andersson, Swen-Olof ; Bratell, Stefan ; Spångberg, Anders ; Palmgren, Juni ; Adami, Hans-Olov ; Johansson, Jan-Erik
Assuntos: Aged ; Biological and medical sciences ; Clinical trials ; Follow-Up Studies ; Humans ; Kirurgi ; Male ; Medical sciences ; MEDICIN ; Medicin och hälsovetenskap ; MEDICINE ; Middle Aged ; Mortality ; Neoplasm Staging ; Nephrology. Urinary tract diseases ; Odds Ratio ; Oncology ; Onkologi ; Proportional Hazards Models ; Prostate cancer ; Prostate-Specific Antigen - blood ; prostatectomy ; Prostatectomy - methods ; Prostatic Neoplasms - immunology ; Prostatic Neoplasms - mortality ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Prostatic Neoplasms/immunology/mortality/pathology/surgery ; Research Design ; Risk Assessment ; Risk factors ; Scandinavia/epidemiology ; Scandinavian and Nordic Countries - epidemiology ; Surgery ; Survival analysis ; Time Factors ; Tumors ; Tumors of the urinary system ; Urinary tract. Prostate gland
É parte de: JNCI : Journal of the National Cancer Institute, 2008-08, Vol.100 (16), p.1144-1154
Notas: ark:/67375/HXZ-4PZ31JNP-4
istex:4E743E690A510B2A6E1C0130DC92C65E85AB8F1C
Descrição: Background The benefit of radical prostatectomy in patients with early prostate cancer has been assessed in only one randomized trial. In 2005, we reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. We now report results after 3 more years of follow-up. Methods From October 1, 1989, through February 28, 1999, 695 men with clinically localized prostate cancer were randomly assigned to radical prostatectomy (n = 347) or watchful waiting (n = 348). Follow-up was complete through December 31, 2006, with histopathologic review and blinded evaluation of causes of death. Relative risks (RRs) were estimated using the Cox proportional hazards model. Statistical tests were two-sided. Results During a median of 10.8 years of follow-up (range = 3 weeks to 17.2 years), 137 men in the surgery group and 156 in the watchful waiting group died (P = .09). For 47 of the 347 men (13.5%) who were randomly assigned to surgery and 68 of the 348 men (19.5%) who were not, death was due to prostate cancer. The difference in cumulative incidence of death due to prostate cancer remained stable after about 10 years of follow-up. At 12 years, 12.5% of the surgery group and 17.9% of the watchful waiting group had died of prostate cancer (difference = 5.4%, 95% confidence interval [CI] = 0.2 to 11.1%), for a relative risk of 0.65 (95% CI = 0.45 to 0.94; P = .03). The difference in cumulative incidence of distant metastases did not increase beyond 10 years of follow-up. At 12 years, 19.3% of men in the surgery group and 26% of men in the watchful waiting group had been diagnosed with distant metastases (difference = 6.7%, 95% CI = 0.2 to 13.2%), for a relative risk of 0.65 (95% CI = 0.47 to 0.88; P = .006). Among men who underwent radical prostatectomy, those with extracapsular tumor growth had 14 times the risk of prostate cancer death as those without it (RR = 14.2, 95% CI = 3.3 to 61.8; P < .001). Conclusion Radical prostatectomy reduces prostate cancer mortality and risk of metastases with little or no further increase in benefit 10 or more years after surgery.
Editor: Cary, NC: Oxford University Press
Idioma: Inglês

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Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: the Scandinavian Prostate Cancer Group-4 Randomized Trial

Bill-Axelson, Anna ; Holmberg, Lars ; Filén, Frej ; Ruutu, Mirja ; Garmo, Hans ; Busch, Christer ; Nordling, Stig ; Häggman, Michael ; Andersson, Swen-Olof ; Bratell, Stefan ; Spångberg, Anders ; Palmgren, Juni ; Adami, Hans-Olov ; Johansson, Jan-Erik

Cary, NC: Oxford University Press

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