Prostatectomy vs. Observation for Prostate Cancer: PIVOT

Allan S. Brett, MD

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Interpretation of these results likely will depend on one's preconceptions. Clinicians predisposed to no intervention will emphasize the overall results, which suggest low probability of benefiting from radical prostatectomy. Clinicians predisposed to aggressive intervention will note that prostatectomy was associated with significantly lower 10-year mortality in prespecified subgroups. Some people will argue that PIVOT was underpowered; indeed, it fell short of its original enrollment goal of 2000 participants. Nevertheless, these findings comprise the best available data and should be used by urologists, oncologists, and primary care physicians to guide clinical decision making. Finally, given that surgery was ineffective for men with PSA levels ≤10 ng/mL, it will be interesting to see whether PSA screening supporters will revise upward their favored PSA thresholds for triggering biopsy.

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