Anna Bill-Axelson, M.D., Ph.D. (left), Lars Holmberg, M.D., Ph.D., Mirja Ruutu, M.D., Ph.D., Hans Garmo, Ph.D., Jennifer R. Stark, Sc.D., Christer Busch, M.D., Ph.D., Stig Nordling, M.D., Ph.D., Michael Häggman, M.D., Ph.D., Swen-Olof Andersson, M.D., Ph.D., Stefan Bratell, M.D., Ph.D., Anders Spångberg, M.D., Ph.D., Juni Palmgren, Ph.D., Gunnar Steineck, M.D., Ph.D., Hans-Olov Adami, M.D., Ph.D., and Jan-Erik Johansson, M.D., Ph.D. for the SPCG-4 Investigators
N Engl J Med 2011; 364:1708-1717 May 5, 2011
Background
In 2008, we reported that radical prostatectomy, as compared with watchful waiting, reduces the rate of death from prostate cancer. After an additional 3 years of follow-up, we now report estimated 15-year results.
Vid en operation tar kirurgen bort hela körteln och även de båda sädesblåsorna. Detta kallas för radikal prostatektomi (radical prostatectomy)
Methods
From October 1989 through February 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy. Follow-up was complete through December 2009, with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death. Relative risks, with 95% confidence intervals, were estimated with the use of a Cox proportional-hazards model.
Studiet av vävnader kallas histologi eller, om det rör sjukdomar, histopatologi (histopathological)
Biopsi (biopsy) = vävnadsprov.
Results
During a median of 12.8 years, 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died (P=0.007). In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting, death was due to prostate cancer. This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6% and 20.7%, respectively (a difference of 6.1 percentage points; 95% confidence interval [CI], 0.2 to 12.0), and a relative risk with surgery of 0.62 (95% CI, 0.44 to 0.87; P=0.01). The survival benefit was similar before and after 9 years of follow-up, was observed also among men with low-risk prostate cancer, and was confined to men younger than 65 years of age. The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age. Among men who underwent radical prostatectomy, those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth (relative risk, 6.9; 95% CI, 2.6 to 18.4).
Kumulativ incidens (cumulative incidence): antalet personer som utvecklar en sjukdom under en viss tid.
Conclusions
Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment. (Funded by the Swedish Cancer Society and the National Institutes of Health.)
Swedish Cancer Society = Cancerfonden
http://www.nejm.org/doi/full/10.1056/NEJMoa1011967
National Institutes of Health (förkortas ofta NIH) är en myndighet som lyder under den amerikanska federala regeringens departement för hälsovård och socialomsorg (Department of Health and Human Services). NIH svarar för finansieringen av cirka 28 procent av all medicinsk forskning som sker i USA, vilket för NIH:s del uppgår till cirka 28 miljarder dollar årligen. NIH är därmed världens största statliga forskningsfinansiär. Huvudkontoret ligger i Bethesda i Maryland.
Nödvändigt tillägg (???): Efter provtagningar (regelbundna) har det sagts att jag jälv inte misstänks ha
prostatacancer. "Regelbundna provtagningar" rekommenderas inte bara mig, utan alla gubar.
Onkologen Sten Nilssons tankar om "vad som väntar runt hörnet inom prostatacancerforskningen"(video):
http://www.youtube.com/user/cancerfonden
