Prostate cancer: Send away the PSA?

摘要

Sometimes the war on cancer should be a cold war, not a hot one. That is the message from the Prostate Cancer Intervention versus Observation Trial (PIVOT) by Timothy Wilt and colleagues, published in the New England Journal of Medicine on July 19. The researchers asked: when localised prostate cancer is detected in men younger than 75 years of age by means of the prostate-specific antigen (PSA) test, how does surgical resection compare with watchful waiting in terms of mortality? The results, from 731 men randomly assigned to either surgery or observation and followed up for a median of 10 years, showed that “Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation”. Furthermore, urological symptoms such as urinary incontinence and erectile dysfunction were significantly more common in the surgical intervention group at 2 years.