The PIVOT trial compared radical prostatectomy versus observation for clinically localised prostate cancer. After 20 years of follow-up (published 2022), the primary outcome showed:
- A Significant improvement in overall survival with radical prostatectomy in all risk groups
- B No significant difference in overall survival; modest reduction in prostate cancer-specific mortality with surgery ✓
- C Surgery improved overall survival only in high-risk patients (PSA >10 ng/mL)
- D Active surveillance was superior to surgery for low- and intermediate-risk disease
Correct answer: B. No significant difference in overall survival; modest reduction in prostate cancer-specific mortality with surgery
Explanation
The PIVOT trial's 20-year extended follow-up found no statistically significant difference in overall survival between radical prostatectomy and observation (HR 0.84, 95% CI 0.70–1.01). However, surgery was associated with a modest reduction in prostate cancer-specific mortality (5.5% vs 7.4%), particularly in men with intermediate or high-risk disease. This supports current practice of shared decision-making rather than universal surgical treatment for clinically localised prostate cancer.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.