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PIVOT
About the Trial
The Prostate Cancer Intervention versus Observation Trial randomized 731 American men with localized prostate cancer, mostly PSA detected, to radical prostatectomy or observation. Over about 10 years of follow up, surgery did not reduce all cause or prostate cancer mortality overall. Subgroup analysis suggested benefit in men with PSA over 10 or higher risk disease. PIVOT tempered the overtreatment concerns ignited by PSA screening, showing many screen detected cancers pose limited threat. Alongside ProtecT, which found similar mortality with active monitoring, surgery, or radiation over 10 years, PIVOT anchored the active surveillance movement, under which many men with low risk disease are monitored rather than treated immediately.
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