Comparing Watchful Waiting and Radical Prostatectomy Outcomes in Early Prostate Cancer: A Single-Center Study

Bharadwaj, Hareesha and Dalal, Priyal (2024) Comparing Watchful Waiting and Radical Prostatectomy Outcomes in Early Prostate Cancer: A Single-Center Study. European Journal of Surgical Oncology, 50 (1).

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Background: The optimal management approach for early prostate-cancer remains a topic of debate. This study aimed to compare the outcomes of watchful-waiting versus radical-prostatectomy in patients with prostate-cancer in UAE. This study also aimed to contribute to the deficit of studies from the region.

Methods: A retrospective analysis was conducted on prostate-cancer patients who underwent watchful-waiting (n = 50) or radical-prostatectomy (n = 45) between 2015 and 2023. Patient demographics, clinical-characteristics, and follow-up data were collected. Primary endpoint was disease-specific mortality; secondary endpoints were overall mortality, metastasis, and local tumor progression. Statistical analysis employed appropriate tests.

Results: Average age for the watchful-waiting cohort was 68.3 years, whereas that of the radical-prostatectomy group was 65.7 years. Within the watchful-waiting group, 24% (12 patients) experienced prostate-cancer-related mortality, contrasting with the radical-prostatectomy group's 11% (5 patients) (p = 0.12). Disease-specific mortality rates were 7% for watchful-waiting and 3% for radical-prostatectomy. Overall mortality figures were 18% for watchful-waiting and 13% for radical-prostatectomy (p = 0.36). Comparatively, radical-prostatectomy was linked to a notably reduced risk of metastasis compared to watchful-waiting (8% vs. 22%, p = 0.03). Assessing local tumor progression rates of watchful-waiting cohort was 13%, whereas it was 6% (p = 0.18) in the radical-prostatectomy group.

Conclusion: This single-center study comparing watchful-waiting and radical-prostatectomy outcomes in early prostate-cancer suggests a potential benefit of surgical intervention. Radical-prostatectomy demonstrated a trend towards lower disease-specific mortality and significantly reduced the risk of metastasis compared to watchful-waiting. In addition, overall mortality-rates were also lower in the radical-prostatectomy group.

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