Minimal difference in survival between radical prostatectomy and observation in men with modest life expectancy.

Commentary on : Wilt TJ, Jones KM, Barry MJ, et al . Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 2017;377:132–42. Screening, diagnosis and management of localised prostate cancer remains controversial. Prostate Cancer Intervention Versus Observation Trial (PIVOT) was a randomised controlled trial that accrued 731 men with prostate cancer (PCa) between 1994 and 2002 from Veterans Affairs hospitals. Patients were randomised to radical prostatectomy (n=364) or observation (n=367). Inclusion criteria was clinical stage T1–T2 (organ confined), prostate-specific antigen (PSA) 10 years. Primary and secondary outcomes were all-cause and prostate-cancer mortality. Median age was 67 years, median PSA 7.8 ng/mL and 45% of patients were clinical stage T2 (palpable on exam). After 19.5 years follow-up (median 12.7 years), cumulative all-cause mortality was similar between surgery and observation (61.3% vs 66.8%; HR 0.84; 95% CI 0.70 …