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Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer

Bill-Axelson, Anna, Holmberg, Lars, Ruutu, Mirja, Garmo, Hans, Stark, Jennifer R., Busch, Christer, Nordling, Stig, Häggman, Michael, Andersson, Swen-Olof, Bratell, Stefan, Spångberg, Anders, Palmgren, Juni, Steineck, Gunnar, Adami, Hans-Olov, Johansson, Jan-Erik·2011·New England Journal of Medicine

Abstract

BACKGROUND: In 2008, we reported that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, we now report estimated 15-year results. METHODS: From October 1989 through February 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy. Follow-up was complete through December 2009, with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death. Relative risks, with 95% confidence intervals, were estimated with the use of a Cox proportional-hazards model. RESULTS: During a median of 12.8 years, 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died (P=0.007). In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting, death was due to prostate cancer. This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6% and 20.7%, respectively (a difference of 6.1 percentage points; 95% confidence interval [CI], 0.2 to 12.0), and a relative risk with surgery of 0.62 (95% CI, 0.44 to 0.87; P=0.01). The survival benefit was similar before and after 9 years of follow-up, was observed also among men with low-risk prostate cancer, and was confined to men younger than 65 years of age. The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age. Among men who underwent radical prostatectomy, those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth (relative risk, 6.9; 95% CI, 2.6 to 18.4). CONCLUSIONS: Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment. (Funded by the Swedish Cancer Society and the National Institutes of Health.).

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Metadata

Authors
Bill-Axelson, A., Holmberg, L., Ruutu, M., Garmo, H., Stark, J. R., Busch, C., Nordling, S., Häggman, M., Andersson, S.-O., Bratell, S., Spångberg, A., Palmgren, J., Steineck, G., Adami, H.-O., & Johansson, J.-E.
Venue
New England Journal of Medicine
Published
2011-05-05
Volume
364
Issue
18
Pages
1708-1717
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2145221548
Cited by
1,900
References
2
FWCI
171.23
Type
journal article
Language
en
Open access
closed

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CoChat. (2026). Citation check: Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer. https://app.cochat.ai/papers/10.1056/nejmoa1011967
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Bill-Axelson, A., Holmberg, L., Ruutu, M., Garmo, H., Stark, J. R., Busch, C., Nordling, S., Häggman, M., Andersson, S.-O., Bratell, S., Spångberg, A., Palmgren, J., Steineck, G., Adami, H.-O., & Johansson, J.-E. (2011). Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1011967

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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