29-year follow-up of Swedish prostate cancer patients


Conclusions from the Scandinavian Prostate Cancer Group Study Number Four (SPCG-4), published in New England Journal of Medicine in December 2018, show that men with clinically detected prostate cancer can benefit from radical prostatectomy. The study is a strong indication of the value for cancer research of complete, long-term follow-up data and high study-adherance. The value of clinical data and patient registries to the development of cancer care was strongly advocated for at Uppsala Health Summit, “Care for Cancer”, in June 2018.

The group of authors, led by Anna Bill-Axelson at Uppsala University Hospital, reports that mortality in the group of patients that underwent radical prostatectomy was 11.7 percentage points lower than in the group of patients whose condition was managed by watchful waiting. On average, men who had been operated on lived 2.9 years longer than the men who received treatment of symptoms only. However, the authors note that the number of extra years gained is a crude measure, and that conclusions for clinical practice will depend on the patient’s baseline risk which can be better estimated as diagnostic methods develop. The study also indicates that if the patient is expected to benefit from surgery, interventions should not be delayed.

Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up, N Engl J Med 2018;379:2319-29. DOI: 10.1056/NEJMoa1807801.