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Radical prostatectomy vs watchful waiting

The New England Journal of Medicine rarely publishes follow-up studies for articles previously published in that prestigious journal. The excellent randomized prospective study of radical prostatectomy (RP) vs watchful waiting from the Scandinavian Prostate Cancer Group Study [1], with an additional 3 years of follow-up, has yielded statistically significant differences in both primary endpoint of death from prostate cancer and the secondary endpoints of death from any cause, distant metastases, and local progression. This study, which accumulated 695 men from 14 centres from 1989 to 1999, included patients with clinical stage T1 or T2 prostate cancer, a PSA level of < 50 ng/mL and negative bone scans. The patients were stratified according to tumour grade and randomization centre, and were randomly assigned to undergo either RP or watchful waiting. Analysis was by intention to treat, with a 5% crossover in the RP group and a 10% crossover in the watchful-waiting group.