An Editorial Update: Should Benefits of Radical Prostatectomy Affect the Decision To Screen for Early Prostate Cancer?

In 2002, Annals published a systematic review that addressed several issues relevant to prostate cancer screening (1). Based on the review, the U.S. Preventive Services Task Force gave prostate cancer screening a grade I recommendation, which means that the members thought that the evidence about the balance of benefits and harms of screening was insufficient to make a stronger recommendation (2). The Task Force had the following concerns: 1) There was only “mixed and inconclusive” evidence that early treatment of prostate cancer could prevent adverse outcomes and 2) treatment was associated with a high risk for substantial harm, principally urinary incontinence and erectile dysfunction. The Task Force suggested that physicians inform men older than 50 years of age about the uncertainty of the evidence for net benefit and that they help men reach individual, informed decisions about screening.

In the 2002 systematic review, Harris and Lohr cited “radical prostatectomy as the most common treatment for clinically localized prostate cancer.” Yet they found only 1 well-conducted randomized trial that compared radical prostatectomy with watchful waiting for men with clinically detected prostate cancer (1, 3). After a mean follow-up time of 6.2 years, this trial from Sweden had shown no statistically significant difference in all-cause mortality between groups. However, 7.1% of the men assigned to radical prostatectomy had died of prostate cancer compared with 13.6% of those assigned to watchful waiting. As the follow-up time was relatively short in light of the often prolonged natural history of prostate cancer, many people looked forward to the publication …