Similar 10-Year Survival Reported With Active Monitoring, Surgery, or Radiotherapy for PSA-Detected Localized Prostate Cancer
In a UK trial (ProtecT) reported in The New England Journal of Medicine, Hamdy et al found no significant differences in prostate cancer–specific or overall mortality among men with localized prostate cancer detected by prostate-specific antigen (PSA) testing who underwent active monitoring, surgery, or radiotherapy. Metastases and disease progression were more common with monitoring.
Study Details
In the study, 1,643 men aged 50 to 69 years (median, 62 years) were randomized between 1999 and 2009 to receive active monitoring (n = 545), surgery (n = 553), or radiotherapy (n = 545). The primary outcome measure was prostate cancer mortality at a median of 10 years of follow-up. Radical treatment was received by 54.8% of the active monitoring group by the end of November 2015; of them, 49% underwent surgery, 33% received per-protocol radiotherapy, and 8% received brachytherapy.
Survival
During the median 10-year follow-up, prostate cancer–specific deaths (n = 17) occurred in 8 patients in the monitoring group (1.5 deaths per 1,000 person-years), 5 in the surgery group (0.9/1,000 person-years), and 4 in the radiotherapy group (0.7/1,000 person-years; P = .48 for overall comparison). Prostate cancer–specific survival was ≥ 98.8% in all groups. Hazard ratios were 0.51 (95% confidence interval [CI] = 0.15–1.69) for radiotherapy vs monitoring, 0.80 (95% CI = 0.22–2.99) for radiotherapy vs surgery, and 0.63 (95% CI = 0.21–1.93) for surgery vs monitoring. All-cause death rates/1,000 person-years were 10.9 with active monitoring, 10.1 for surgery, and 10.3 for radiotherapy (P = .87 for overall comparison).
Metastases and Disease Progression
Metastases were more common in the active monitoring group (33 patients, 6.3/1,000 person-years) vs the surgery group (13 patients, 2.4/1,000 person-years) and the radiotherapy group (16 patients, 3.0/1,000 person-years; P = .004 for overall comparison). Disease progression was more common in the monitoring group (112 patients, 22.9/1,000 person-years) vs the surgery group (46 patients, 8.9/1,000 person-years) and the radiotherapy group (46 patients, 9.0/1,000 person-years; P < .001 for overall comparison).
The investigators concluded: “At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.”
The study was funded by the UK National Institute for Health Research.
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