Survival after radical prostatectomy. (Mindful Practice).

* For limited-stage prostate cancer, there is no difference in overall mortality between watchful waiting and radical prostatectomy during a median follow-up of 6 years.

* For limited-stage prostate cancer, there is a lower rate of disease-specific mortality and development of distant metastases with radical prostatectomy compared with watchful. waiting during a median follow-up of 6 years.

The Problem

A 64-year-old male with Korsakoff's syndrome is admitted to a nursing home from an outside institution. He has a prostate-specific antigen (PSA) of 21.1 [micro]g/L (normal is less than 4 [micro]g/L). He has no complaints and is a poor historian. He has become increasingly combative in recent months. Upon examination, he is oriented to person and place and refuses testing of any kind. His family is aware of the PSA value, wants everything done; they wonder if surgery would prolong his life if he has prostate cancer. They are told that the next appropriate step would be transrectal-ultrasound-guided biopsy, but this is worth doing only if the patient and the family accept surgery as the next step.

The Question

In prostate cancer patients, does radical prostatectomy improve survival compared with clinical observation?

Seeking Evidence