With the advent of new prostate cancer screening guidelines from the United States Preventive Services Task Force (USPSTF; http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm) the debate continues with regard to active versus surveillance treatment for localized prostate cancer. To date, only 1 randomized trial has compared radical prostatectomy to active surveillance.
This trial reviewed the records of 44,694 patients treated with radical prostatectomy versus observation between 1992 and 2005 in the SEER (Surveillance, Epidemiology, and End Results)-Medicare database. The number needed to treat to prevent a single adverse outcome ranged from 29 to 34 across the various Charlson comorbidity indices. The 10-year cancer-specific mortality rate in men treated with radical prostatectomy versus observation was 5.2% compared to 12.8% for high risk prostate cancer, and 1.4% versus 3.8% for low to intermediate risk prostate cancer.
The authors of this trial conclude that men with high risk prostate cancer gain the largest survival benefit with radical prostatectomy, while the lowest benefit was observed in men with low to intermediate risk prostate cancer. Given that this was observational data, the results may have been attributable to treatment bias. Similar to previous trials, men who received active treatment longer than 6 months after diagnosis were placed in the observation group. In most cases, prostate-specific antigen (PSA) values were not available, thus subjects could not be stratified by this measurement.
Reference: Abdollah F, Sun M, Schmitges J, et al. Survival benefit of radical prostatectomy in patients with localized prostate cancer: estimations of the number needed to treat according to tumor and patient characteristics. J Urol 2012;188:73-83.