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HomeFirst Lookindex/list_13473_12Active Treatment or Observation for Localized Prostate Cancer?

Active Treatment or Observation for Localized Prostate Cancer?

This study was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Compared with observation, active treatment lowers the risk for overall and prostate cancer-specific death in men with localized prostate cancer, particularly those with intermediate or high-risk disease.

  • Radical prostatectomy, in particular, improved prostate cancer-specific survival in both men with intermediate- and high-risk disease.

  • Observation should be the preferred option for men with low-risk disease.

Why This Matters

  • Data on localized prostate cancer survival based on initial treatment strategy and risk group are limited.

  • The initial treatment strategy for intermediate and high-risk disease remains controversial.

  • Demonstrating a survival benefit with active treatment for patients with intermediate and high-risk disease may help clarify the preferred approach.

Study Design

  • The team analyzed localized stage T1c-2cN0M0 prostate cancer cases using the Surveillance, Epidemiology, and End Results (SEER) data from 2010-2016.

  • Researchers compared outcomes between observation, radiotherapy, and radical prostatectomy.

  • The team used an inverse probability of treatment weighting (IPTW) adjustment to increase the 176,456 eligible patients in SEER to a pseudo-population of 521,656, including 175,628 men who had radiotherapy, 175,600 who had radical prostatectomy, and 170,428 who underwent observation.

  • Prostate cancer risk was assessed by D’Amico classification.

  • Subjects were 50-79 years old with prostate-specific antigen levels of 50 ng/mL or less.

  • Median follow-up was 36.5 months.

Key Results

  • After IPTW-adjustment, observation had the lowest 5-year overall survival rate (91.6%), followed by radiotherapy (92.4%), and radical prostatectomy (96.1%; P < .001).

  • Compared with observation, radiotherapy improved prostate cancer-specific survival only in the high-risk group, whereas radical prostatectomy was significantly associated with improved prostate cancer-specific survival among both intermediate (hazard ratio [HR], 0.43) and high-risk men (HR, 0.36) (P < .001 for both).

  • Active treatment, however, did not confer a prostate cancer-specific survival benefit in low-risk disease.


  • Despite the robust analytic methods, there may have been insufficient balancing between the groups.

  • The analysis didn’t distinguish between watchful waiting and active surveillance in the observation arm.

  • Treatment side effects and complications were not considered.


  • The work was funded by the Ministry of Health & Welfare of the Republic of Korea and others.

  • The investigators did not report any conflicts of interest.

This is a summary of a preprint research study, “Observation, radiotherapy, or radical prostatectomy for localized prostate cancer: Survival analysis in the United States,” led by Chang Wook Jeong of Seoul National University Hospital, Seoul, South Korea. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email:

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