Radical Prostatectomy versus Observation for Localized Prostate Cancer

Over 700 men were assigned to radical prostatectomy or observation after receiving a diagnosis of prostate cancer, usually on the basis of elevated PSA levels. After a median of 10 years, between-group differences in all-cause and prostate-cancer mortality were not significant. The treatment of early-stage prostate cancer remains controversial, especially for tumors detected by means of prostate-specific antigen (PSA) testing. 1 Systematic reviews have provided inadequate information for assessing the comparative effectiveness of treatments and any associated harms. 2 Although the lifetime risk of receiving a diagnosis of prostate cancer is about 17%, the risk of dying from the disease is approximately 3%, suggesting that conservative management may be appropriate for many men. 3 , 4 Two randomized trials compared radical prostatectomy with observation but were conducted before PSA testing became widespread. 5 , 6 One study failed to show a significant difference in overall mortality after . . .