According to the World Health Organization (WHO), there were more than 1.2 million new cases of prostate cancer and more than 350,000 deaths attributed to prostate cancer worldwide in 2018.1 In the United States alone, there were an estimated 174,650 new cases of prostate cancer in men (~20% of all new cancer cases) with a lifetime risk of approximately 1 in 9.2 The incidence of prostate cancer declined between 2011 and 2015 by 7% per year, which is most likely a result of updates to US Preventive Services Task Force (USPSTF) recommendations to limit prostate specific antigen (PSA) testing in men.2,3 When patients are diagnosed with prostate cancer, their overall prognosis is generally encouraging; in the US, the highest 5-year cancer relative survival rate is 98%.2

An elevated PSA alone is not enough to diagnose prostate cancer. For this diagnosis, prostate tissue must be obtained. Once diagnosed, treatment options are typically based on the extent (eg, localized) and risk group assessment as per the National Comprehensive Cancer Network (NCCN) with risks ranging from: very low, low, favorable intermediate, unfavorable intermediate, high, very high. Based on the extent and risk group, several treatment options could be available: surveillance (watchful waiting and monitoring), brachytherapy, androgen deprivation therapy (ADT), external beam radiation therapy, and radical prostatectomy (RP).4,5

Two of the more common treatment approaches in patients with clinically detected localized prostate cancer include watchful waiting and RP. RP can be done using a minimally invasive or open approach. After this procedure, the most commonly reported side effects include erectile dysfunction (ED) and urinary incontinence.6 The decision on which treatment option to choose can be challenging for patients; both the short- and long-term data are important to consider.

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Until recently, there was a paucity of long-term data comparing the outcomes in patients with localized prostate cancer who undergo RP to those who choose to undergo watchful waiting. Bill-Axelson and colleagues recently evaluated these long-term outcomes and published their findings in the New England Journal of Medicine.7 The authors compared the long-term survival benefit of watchful waiting to RP in patients with localized prostate cancer from 14 centers in Scandinavia (Sweden, Finland, and Iceland) between October 1989 and February 1999.

This particular study was conducted because80% of the initial patients enrolled had passed away by the end of 2017; this factor allowed for a more robust analysis of the study cohort. Patients who were younger than 75 years, had a life expectancy of greater than 10 years, had no other known cancers, and had a PSA of less than 50 ng/mL were initially randomized to either RP or watchful waiting.