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/NEJMoa1311593

  • Prostate surgery edges slightly ahead of ’watchful waiting’ in study - CNN.com
    http://edition.cnn.com/2014/03/05/health/prostate-surgery-study

    When it comes to prostate cancer, aggressive surgery saves lives and leads to a better quality of life, according to a new study that could inflame the debate over how best to treat the disease — and in some cases, whether to treat it at all.
    The paper, published in the New England Journal of Medicine, is an update on a study that was launched in Sweden, Finland and Iceland a quarter-century ago. Nearly 700 men newly diagnosed with prostate cancer were split into two groups: half had their prostate gland fully removed — a radical prostatectomy — and half were followed through a protocol of “watchful waiting,” where doctors only treated them if symptoms progressed.
    On average, men who underwent immediate surgery lived longer, were less likely to see the cancer spread and had fewer complications from the disease. The longevity benefit was greatest for men in their 50s and early 60s, where over an 18-year period, surgery cut the death rate by more than a third.

    Le papier d’origine #paywall
    Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer — NEJM
    http://www.nejm.org/doi/full/10.1056/NEJMoa1311593

    RESULTS
    During 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04).
    CONCLUSIONS
    Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment.

    La suite de l’article de CNN rend la lecture plus confuse, car il donne la parole à des spécialistes non signataires de l’étude qui donnent leurs points de vue. Essentiellement,

    Carroll agrees that mortality is only part of the picture and says the new study underscores a need to better differentiate between high- and low-risk cancers.

    Yapuka…