A total of 447 of the 695 men enrolled in the study (64%) had died by the end of 2012. This total included 200 men in the radical-prostatectomy group and 247 men in the watchful-waiting group. The cumulative incidence of death at 18 years was 56.1% in the radical-prostatectomy group and 68.9% in the watchful-waiting group (a difference of 12.7 percentage points; 95% confidence interval [CI], 5.1 to 20.3), corresponding to a relative risk of death in the radical-prostatectomy group of 0.71 (95% CI, 0.59 to 0.86; P<0 .="">0>
The authors conclude:
A significant absolute reduction in the rate of death from any cause, the rate of death from prostate cancer, and the risk of metastases in the radical-prostatectomy group continued after up to 23.2 years of follow-up (median, 13.4 years), with no evidence that these benefits diminished over time. In analyses according to age and tumor risk, the effects were more pronounced in men younger than 65 years of age and in men with intermediate-risk tumors. However, among men older than 65 years of age who underwent radical prostatectomy, there was a significantly decreased risk of metastases and need for palliative treatment. We observed a substantial difference in the prevalence of disease burden between the study groups.
From SSI data we have the following Figure of percent surviving from 65 onwards. Note that by 87 years of age only 33% of those alive at 65 are still living. This is for all causes.
Now the data from the study can be compared as follows:
1. Death from any cause in prostatectomy group was 56%
2. Death from any cause in the watchful waiting group was 69%
3. Death from any cause in the general population was at 66%.
4. Death from any cause in the combined groups was 68%.
The conclusion is quite interesting. Those having a prostatectomy actually lived longer no matter what than all others. Therefore, the USPTF’s concern of unwarranted prostatectomies is greatly in question. Now SEER data lists 2.6 million with PCa in the US. Making a gross calculation we could state that the 13% difference would result in an excess 338,000 cumulative deaths if we adhere to watchful waiting. That is more than 100 times those lost in 9/11.
One must be concerned that data of this sort will be denied under CER methods so as to reduce costs in the ACA world. Again this is just an observation.