August 1, 2012Volume 7 - Issue 31

DynaMed Weekly Update

For the week ending July 27, 2012

Last week 805 articles were evaluated via DynaMed's Systematic Literature Surveillance and 347 were added to DynaMed content.   

 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Radical Prostatectomy May Not Reduce Mortality in Most Men with Localized Prostate Cancer Compared to Watchful Waiting

 

Prostate cancer is the most common cancer in men (not counting skin cancer) and the second most common cause of cancer deaths in men, but many aspects of the management of this disease are controversial. PSA screening has become common over the last 2 decades, and has contributed to increased detection rates of early stage low-risk disease (of note, the United States Preventive Services Task Force [USPSTF] recently issued a statement recommending against routine prostate-specific antigen [PSA] screening for all men, regardless of age [Ann Intern Med 2012 May 21 early online] [DynaMed Weekly Update Vol 7, issue 22])  The best treatment for men with low-risk prostate cancer remains unclear.  At the extremes are radical prostatectomy and watchful waiting, but comparative efficacy studies have been inconclusive to date (Cochrane Database Syst Rev 2010 Nov 10;(11):CD006590). 

 

The PIVOT trial compared radical prostatectomy to watchful waiting in 731 men with localized prostate cancer detected by PSA testing.  Men ≤ 75 years old (mean age 67 years) were randomized to radical prostatectomy vs. watchful waiting from 1994 to 2002 and were followed for up to 15 years (median follow-up 10 years).  At baseline, all men had PSA < 50 ng/mL and life expectancy of ≥ 10 years.

 

During the trial, 77.2% of the radical prostatectomy group and 79.6% of the watchful waiting group received their allocated treatment.  There was no significant difference in all-cause mortality between the 2 groups (47% vs.49.9%) (level 2 [mid-level] evidence) in the overall intention-to-treat analysis, but prostatectomy was associated with a trend toward reduced prostate cancer-related mortality (5.8% vs. 8.4%, p = 0.09).  In a subgroup analysis of 251 men with PSA > 10 ng/mL at baseline, however, prostatectomy was associated with significant reductions in both all-cause mortality (48.4% vs. 61.6%, p < 0.05, NNT 8) and prostate cancer-related mortality (5.6% vs. 12.8%, p < 0.05, NNT 14) (N Engl J Med 2012 Jul 19;367(3):203). 

 

For more information, see the Prostate cancer topic in DynaMed.

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: August 1, 2012
Expiration Date: August 1, 2013
Estimated Completion Time:
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Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

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AAFPEnduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  

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