More important.question....... What is the rate of prostate metastasis in men at low risk. 65y.o. Gleason 6 psa 4to6. Ballpark figure ........should have some inkling from all the registries. Any urology specialists' opinions? How about biopsies every year or two or or three. How much does active surveillance mitigate against the risk of developing metastatic disease?
18-Year Follow-Up Confirms Benefit of Prostatectomy Over Watchful Waiting in Early Cancer — Physician’s First Watch
18-Year Follow-Up Confirms Benefit of Prostatectomy Over Watchful Waiting in Early Cancer
By Amy Orciari Herman
Prostatectomy is associated with lower prostate-cancer mortality than watchful waiting even after nearly 20 years of follow-up, according to long-term results from the Scandinavian Prostate Cancer Group Study Number 4, published in the New England Journal of Medicine.
Some 700 men with early prostate cancer were randomized to radical prostatectomy or watchful waiting. The cumulative incidence of disease-specific mortality at 18 years was reduced in the surgery group versus the observation group (18% vs. 29%). The reduction was significant only for men younger than 65, in whom the number needed to treat to prevent one prostate cancer death was four.
Among men aged 65 and older, prostatectomy was associated with significantly lower risks for metastases and need for palliative therapy.
In terms of morbidity, the groups had similar rates of erectile dysfunction (roughly 80%), but the surgery group had a higher incidence of urinary leakage than the watchful-waiting group (41% vs. 11%).