Is Prostatectomy Effective or Necessary?

Here’s a study that’s likely to raise a few eyebrows and voices as well: the authors of the world’s largest randomized trial of prostate cancer have found that prostatectomy for prostate cancer is ineffective. That is, prostatectomy (prostate surgery) did not extend life for men who underwent the surgery when compared with men who chose watchful waiting (now referred to as active surveillance).

Although the results of the study, the Prostate Intervention Versus Observation Trial (PIVOT), have not yet been published, they are already causing a stir, especially among cancer specialists, and here’s why.

The lead author of the study, Timothy Wilt, and his team started the study in 1994 with 731 men with prostate cancer and followed them for up to 12 years. A comparison of survival among men who underwent prostatectomy with those who chose watchful waiting showed that surgery did not extend life.

In the words of a leading British specialist who asked not to be identified, “The only rational response to these results is, when presented with a patient with prostate cancer, to do nothing.”

Obviously, every case is different, and for men who are diagnosed with aggressive or latter stage prostate cancer, prostatectomy may be a life-saving choice. However, prostate cancer is slow-growing in up to 50% of cases, and even when left untreated, men often die of something other than prostate cancer.

If nothing else, the results of the PIVOT study are a sharp reminder that when choosing your prostate cancer treatment, men need to seek professional advice from several sources. Men should carefully review all of their options, including medical interventions, alternative treatments,  and the latest treatments, when choosing the best course of treatment, and fully understand the prostate cancer treatment side effects.

Read more in our Prostate Cancer Health Center.


Wilt TJ et al. Radical prostatectomy versus observation for localized prostate cancer. New England Journal of Medicine 2012 Jul 19; 367(3): 203-13

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