Executive Summary
The paper aims to examine the long-term outcomes presented in “Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up” by Bill-Axelson et al. Then it will apply these findings to a clinical scenario of Mr. KM, a 62-year-old patient with localized prostate cancer who must choose between radical prostatectomy and watchful waiting. By relating the study’s results to his situation, the paper will help determine which option may offer him the most favorable balance of benefit and risk.
Radical Prostatectomy vs. Watchful Waiting
Risks of death when patients undergo radical prostatectomy and watchful waiting in prostate cancer therapies:
- Control event rate (watchful waiting) (X) = 110/348 = 0.32.
- Experimental event rate (radical prostatectomy) (Y) = 71/347 = 0.20.
- Relative risk (Y/X) = 0.2/0.32 = 0.625.
- Relative risk reduction (1-RR) = 0.375.
- Absolute risk reduction (X-Y) = 0.12.
- The number needs to be treated (1/ARR) = 8.33%.
As shown above, consideration has been made for the risk of death as the outcome of interest in this case. In addition, watchful waiting is the control group, while radical prostatectomy is the experimental group (Bill-Axelson et al., 2018). From the study, it is evident that a larger number of patients undergoing watchful waiting therapy (32%) died during the cohort period compared to those who were placed under radical prostatectomy therapy (20%). There is a difference of 12% in the rates of death. Regarding the risk of death, the relative risk is 0.625, the relative risk reduction is 0.375, and the absolute risk reduction is 0.12. Consequently, the number that needed to be treated was 8.33%.
The results clearly indicate that watchful waiting has a higher risk of death for the patients than the risk associated with radical prostatectomy. The absolute risk of 0.12 implies that there is a difference of about 12% in the rate of death, which implies that more patients are likely to die when placed under the watchful waiting approach compared to those undergoing radical prostatectomy (Bill-Axelson et al., 2018). The results further imply that radical prostatectomy is a better method of treating prostate cancer in males than watchful waiting in prostate cancer management practice.
As the results indicate, there was a confidence interval (CI) of 95%, which implies that there is a relatively high chance (of 95%) that the mean value of the population of interest lies within the interval (Bill-Axelson et al., 2018). In essence, the 95% confidence interval indicates that the estimate was precise since only 5 out of 100 samples were likely to be out of the upper and lower limits of the interval, even though the study was a cohort approach that took place over 24 years.
Clinical Implications of Study Findings
It is important to apply such results in the clinical setting. In particular, the physician can use the results to explain to Mr. KM the possible outcomes of each of the two therapies under consideration in the case. In this scenario, the results demonstrate that using radical prostatectomy in treating Mr. KM is better than watchful waiting, judging from the risk of death.
As the study shows, there is a high relative risk of death among those who consider watchful waiting as a method of managing prostate cancer. On the contrary, those who undergo radical prostatectomy have a relatively low risk of death during the process. Thus, the physician should advise Mr. KM to consider radical prostatectomy instead of watchful waiting as a means of reducing the probability of death or the need for further treatment to prevent death during the process.
Benefits and Risks of Radical Prostatectomy
By definition, a radical prostatectomy approach is a form of surgical procedure that involves the partial or complete removal of the prostate gland as a means of treating prostate cancer or benign prostatic hyperplasia. This method has several benefits that are not associated with other approaches, such as watchful waiting and chemotherapy. For instance, the surgery has a high success rate, and many patients are cured after the process.
Studies have shown that patients have a high likelihood of total recovery, with at least ten more years of living normally before other associated symptoms appear. Secondly, removing the entire gland gives physicians a high accuracy rate in assessing the aggressiveness of cancer (Bill-Axelson et al., 2018). It is also possible to immediately and quickly determine whether the procedure was effective and to what extent.
Furthermore, the therapist will have the opportunity to consider follow-up treatments with other modalities, such as radiation, if necessary. It is also worth noting that radical prostatectomy is associated with a relatively limited risk of recurrence, generally beyond five years, and which can be detected with PSA testing (Bill-Axelson et al., 2018). However, it has some risks, such as urinary incontinence, leakage, or dribbling, erectile dysfunction, sterility, lymphedema, infection, and a decrease in the length of the penis.
Reference
Bill-Axelson, A., Holmberg, L., Garmo, H., Taari, K., Busch, C., Nordling, S., Haggman, M., Andersson, S., Andren, O., Steineck, G., Adami, H., & Johansson, J. E. (2018). Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. New England Journal of Medicine, 379(24), 2319-2329. Web.