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Delaying treatment for localised prostate cancer does not increase mortality risk, trial shows

By Priscilla Lynch - 19th Mar 2023

prostate cancer

Active monitoring of prostate cancer has the same high survival rates after 15 years as radiotherapy or surgery, reports the largest study of its kind. The latest findings from the ProtecT trial were presented at the EAU 2023 Annual Congress in Milan and published in the New England Journal of Medicine.

Although men on active monitoring were more likely to see it progress or spread than those receiving radiotherapy or surgery, this didn’t reduce their likelihood of survival. The trial also found that the negative impacts of radiotherapy and surgery on urinary and sexual function persist much longer than previously thought – for up to 12 years.

The findings show that treatment decisions following diagnosis for low- and intermediate-risk localised prostate cancer do not need to be rushed, according to lead investigator, Prof Freddie Hamdy from the University of Oxford. “It’s clear that, unlike many other cancers, a diagnosis of prostate cancer should not be a cause for panic or rushed decision-making,” he said. “Patients and clinicians can and should take their time to weigh up the benefits and possible harms of different treatments in the knowledge that this will not adversely affect their survival.”

The trial, funded by the National Institute for Health and Care Research, was led by researchers at the Universities of Oxford and Bristol in nine UK centres and is the longest running study of its kind. It is the first to fully evaluate three major treatment options: Active monitoring, surgery (radical prostatectomy), and radiotherapy with hormones for men with localised prostate cancer.

Between 1999 and 2009, 1,643 men aged 50-to-69 years across the UK, who were diagnosed with localised prostate cancer after a PSA blood test, agreed to be randomised to active monitoring (545), radical prostatectomy (553), or radical radiotherapy (545). The research team followed the men over an average of 15 years, to measure mortality rates, cancer progression and spread, and the impact of treatments on quality-of-life.

They found that around 97 per cent of the men diagnosed with prostate cancer survived 15 years after diagnosis, irrespective of which treatment they received. Around a quarter of the men on active monitoring had still not had any invasive treatment for their cancer after 15 years. Patients from all three groups reported similar overall quality-of-life, in terms of their general mental and physical health. But the negative effects of surgery or radiotherapy on urinary, bowel, and sexual function were found to persist much longer than previously thought.

In earlier findings released in 2016, the researchers found that, after 10 years follow-up, men whose cancer was being actively monitored were twice as likely to see it progress or metastasise than those in the other groups. The assumption had been that this might lead to a lower survival rate for men on active monitoring over a longer time period. However, the results from the 15-year follow-up show that this isn’t the case and that survival rates remain similarly high across all groups.

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