The PIVOT trial evaluated radical prostatectomy versus active surveillance in men with localised prostate cancer. Its key finding regarding overall mortality was:
- A Radical prostatectomy significantly reduced overall mortality across all risk groups
- B No significant difference in overall mortality between surgery and observation at 12 years for the entire cohort; a subgroup benefit was seen in intermediate/high-risk patients ✓
- C Active surveillance was superior to surgery in all PSA risk categories
- D Surgery improved overall survival only in men over 70 years with high Gleason scores
Explanation
The PIVOT (Prostate Cancer Intervention Versus Observation Trial) found no statistically significant difference in overall or prostate cancer-specific mortality between radical prostatectomy and observation in the entire study cohort at 12 years follow-up. However, subgroup analysis suggested a potential benefit for surgery in men with intermediate-risk disease (PSA >10 ng/mL) and high-risk locally advanced tumours. The ProtecT trial similarly found no difference in 10-year cancer-specific mortality. These trials support active surveillance as acceptable for low-risk disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.