• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

Radical prostatectomy significantly improves survival in localized prostate cancer: the SPCG-4 trial

byJames RoebkerandDayton McMillan
December 13, 2018
in Chronic Disease, Oncology, Surgery, Urology
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Among men under 75 years of age with localized prostate cancer, radical prostatectomy was associated with a significant survival benefit compared to watchful waiting.

2. In patients who underwent radical prostatectomy, extracapsular extension and a Gleason score of 8 or 9 were strong indicators of poor prognosis.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Though radical prostatectomy is a standard option for the management of localized prostate cancer, the optimal role is debated given the surgical morbidity and low mortality rate from prostate cancer. To assess the long-term mortality benefit of radical prostatectomy in this cohort, the landmark Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) trial randomized men with localized prostate cancer to radical prostatectomy or watchful waiting from 1989 to 1999 and published the annually collected follow-up data in three-year intervals since 2002. This study reports outcomes through 2017 and includes histopathologic associations with long-term prognosis. The results demonstrated that patients randomized to radical prostatectomy had a significantly lower rate of all three components of the primary endpoint ( all-cause mortality, prostate cancer mortality, and distant metastatic disease) compared to the watchful waiting group. Additionally, the authors found a strong association between extracapsular extension and Gleason score of 8 or 9 with death from prostate cancer. While a clear mortality benefit from radical prostatectomy in localized prostate cancer was demonstrated, the impact on clinical practice is limited by current differences in prostate cancer detection and treatment.

This trial was strengthened by the long duration of follow-up data and trial initiation prior to routine prostate-specific antigen (PSA) screening, which adds lead time and necessitates additional follow-up to determine treatment effects. This significantly limits generalizability, however, as most patients enrolled had palpable tumors and represent a population different than that seen in modern practice. Furthermore, the mortality benefit from radical prostatectomy still must be balanced with surgical morbidity and cost.

Click to read the study, published today in NEJM

Relevant Reading: Radical prostatectomy versus observation for localized prostate cancer

RELATED REPORTS

Plant-based diets may be associated with lower risk of aggressive prostate cancer

Wellness Check: Nutrition

#VisualAbstract: Positive prostate MRI and targeted biopsy reduce the detection of clinically insignificant prostate cancer

In-Depth [randomized controlled trial]: This was a multicenter trial that randomized 695 men with localized prostate cancer to radical prostatectomy (n=347) or watchful waiting (n=348) between 1989 and 1999. Eligibility required age younger than 75 years, a life expectancy more than 10 years and no other known cancer, PSA level <50 ng/mL, and a localized tumor. The histopathologic margins, extracapsular tumor growth, and Gleason grade were reviewed for available biopsy and surgical specimens of patients in the radical prostatectomy group and assessed for prognostic value. The primary end points were death from any cause, death from prostate cancer, and metastasis.

With follow-up through 2017, 553 (80%) of the 695 men in the study had died and the median follow-up time was 23.6 years. For radical prostatectomy vs. watchful waiting, respectively: the cumulative incidence of death at 23 years was 71.9% vs. 83.8% with a corresponding relative risk [RR] of 0.74 (95% CI, 0.62 to 0.87; P<0.001), the cumulative incidence of death from prostate cancer was 19.6% vs. 31.3% with RR of 0.55 (95% CI, 0.41 to 0.74; P<0.001), and the cumulative incidence of distant metastases was 26.6% vs. 43.3% with RR of 0.54 (95% CI, 0.42 to 0.70; P<0.001). At 23 years, a mean of 2.9 additional years of life was gained from radical prostatectomy. The effect of radical prostatectomy among men younger than 65 years was greater with respect to all three primary endpoints. Regarding histopathologic associations with long-term prognosis in the radical prostatectomy group, extracapsular extension (RR, 5.21; 95% CI, 2.42 to 11.22) and Gleason score of 8 or 9 (RR, 10.63; 95% CI, 3.03 to 37.30) had the greatest association with poor prognosis.

Image: PD

©2018 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc

Tags: prostate cancerprostatectomy
Previous Post

The COAPT: Transcatheter mitral valve repair lowers mortality in patients with heart failure and mitral regurgitation

Next Post

Quick Take: Phase I/II Study of Stem-Cell Transplantation Using a Single Cord Blood Unit Expanded Ex Vivo With Nicotinamide

RelatedReports

Vegetarian diet may lower incidence of colorectal cancer
Lifestyle

Plant-based diets may be associated with lower risk of aggressive prostate cancer

January 27, 2023
Improved glycemic control in type 1 diabetics on very low-carbohydrate diets
Wellness

Wellness Check: Nutrition

January 26, 2023
#VisualAbstract: Positive prostate MRI and targeted biopsy reduce the detection of clinically insignificant prostate cancer
StudyGraphics

#VisualAbstract: Positive prostate MRI and targeted biopsy reduce the detection of clinically insignificant prostate cancer

January 4, 2023
2MM Podcast

The 2 Minute Medicine Podcast Episode 2

November 22, 2022
Next Post
Modified embryonic stem cells may prolong survival of surgical grafts

Quick Take: Phase I/II Study of Stem-Cell Transplantation Using a Single Cord Blood Unit Expanded Ex Vivo With Nicotinamide

Study examines post-discharge pediatric mortality rate in Mozambique

Intensive rehabilitation not superior to traditional therapy for arm function after stroke

Quick Take: Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • BNT162b2 booster is safe and reduces COVID-19 transmission in older adults
  • Bisphosphonates, denosumab, abaloparatide, teriparatide, and romosozumab reduce postmenopausal fracture risk
  • Epstein-Barr viral load monitoring reduces risk of post-liver transplant lymphoproliferative disease
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options