ARTICLE Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: the Scandinavian

Following widespread introduction of prostate-specific antigen (PSA) testing, prostate cancer incidence has increased dramatically in the Western world, including the Nordic countries ( 1). Many of these diagnoses represent clinically irrelevant tumors, and the risk of overdiagnosis and overtreatment poses a tremendous clinical and ethical dilemma ( 2, 3). Central to this dilemma is the knowledge about the effects of localized radical treatment. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) — which predominantly included men whose prostate cancer was not detected by PSA screening — was the first randomized trial to show that radical prostatectomy reduces the risk of prostate cancer mor-tality and the risk of developing metastases ( 4, 5). Key questions following our previous analyses of this trial, which were based on a median of 8.2 years of follow-up, include whether the absolute and relative benefi ts of surgical treatment would increase during longer follow-up, as we hypothesized