# SPCG-4 (Scandinavian Prostate Cancer Group Study 4)

Source: https://onco.cc/trials/spcg-4/  
OnCo record `spcg-4` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The trial that proved an operation for prostate cancer can save a life, in men whose cancer was found because of symptoms rather than a blood test, and that the average gain is about three years.

## Summary

SPCG-4 randomised 695 men with clinically detected localised prostate cancer to radical prostatectomy or watchful waiting between October 1989 and February 1999, and followed them to the end of 2017. These were not screen-detected cancers: most were found because the man had symptoms or an abnormal examination, so the trial says nothing directly about the tumours a PSA test finds.

By 31 December 2017, 261 of 347 men in the prostatectomy group and 292 of 348 in the watchful-waiting group had died. Seventy-one deaths in the prostatectomy group and 110 in the watchful-waiting group were from prostate cancer: relative risk 0.55 (95 percent confidence interval 0.41 to 0.74, p<0.001), an absolute difference of 11.7 percentage points (5.2 to 18.2). The number needed to treat to avert one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life had been gained with surgery.

The trial also produced the two pathological features that still drive counselling after an operation: extracapsular extension carried a risk of death from prostate cancer five times that of men without it, and a Gleason score above 7 carried a risk ten times that of a score of 6 or lower.

SPCG-4 and PIVOT are usually read as contradicting each other. They do not: SPCG-4 treated clinically detected cancers in the pre-PSA era and found a benefit, PIVOT treated mostly PSA-detected cancers and did not. The lesson is that the benefit of surgery depends entirely on how the cancer was found.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: SPCG-4; Scandinavian Prostate Cancer Group Study Number 4; SPCG-4/SFUO-1
- Phase: 3
- Setting: Clinically detected, not screen-detected, localised prostate cancer in men mostly under 75: radical prostatectomy versus watchful waiting, with death from prostate cancer, death from any cause and metastasis as the outcomes, followed to 29 years
- Sponsor: Scandinavian Prostate Cancer Group, funded by the Swedish Cancer Society
- Enrolled: 695
- Result: Prostate cancer deaths 71 of 347 with surgery against 110 of 348 with watchful waiting (relative risk 0.55, 95 percent confidence interval 0.41 to 0.74); number needed to treat 8.4 to avert one death from any cause; mean 2.9 years of life gained at 23 years.
- Outcomes: Death from prostate cancer at 29 years: Radical prostatectomy 71 men vs Watchful waiting 110 men; Death from any cause at 29 years: Radical prostatectomy 261 men vs Watchful waiting 292 men
- Replication: Not replicated in a screen-detected population: PIVOT (mostly PSA-detected, 731 men) found no significant mortality difference, and ProtecT (screen-detected, 1,643 men) found prostate cancer mortality under 3 percent in every arm at 15 years.

## Sources

- SPCG-4 at 29 years (New England Journal of Medicine 2018): https://doi.org/10.1056/NEJMoa1807801

## Connected records

- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- technologies: [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/)
- terms: [Active surveillance and observation](https://onco.cc/terms/active-surveillance-term/), [Choosing treatment for localised prostate cancer: what each option costs](https://onco.cc/terms/prostate-treatment-choice-localised/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/), [Radical prostatectomy](https://onco.cc/terms/prostatectomy/)
- trials: [PIVOT (Prostate Cancer Intervention Versus Observation Trial)](https://onco.cc/trials/pivot/), [ProtecT](https://onco.cc/trials/protect/)

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JSON: https://onco.cc/api/v1/entities/spcg-4.json