Active monitoring does not increase prostate cancer-specific mortality risk, study shows

Active monitoring of prostate cancer has the same 15-year survival rate as radiotherapy or surgery, the largest study of its kind today reports.

The latest findings from the ProtecT trial, led by the Universities of Oxford and Bristol, were presented today at the European Urological Association (EAU) in Milan. New England Journal of Medicine.

This trial was funded by the National Institutes of Health (NIHR).

Men who had active monitoring (including regular tests to check for cancer) were more likely to see cancer progress or metastasize than men who had radiation therapy or surgery. However, it did not reduce the chances of survival.

The study also found that the adverse effects of radiotherapy and surgery on urinary and sexual function persisted for up to 12 years, much longer than previously thought.

According to lead investigator Professor Freddie Hamdy of the University of Oxford, the findings show that there is no need to rush treatment decisions after diagnosis of low- and intermediate-risk localized prostate cancer.

Clearly, unlike many other cancers, a prostate cancer diagnosis does not cause panic or hasty decision-making. Patients and clinicians can and should take the time to weigh the benefits and possible harms of different treatments, knowing that this will not adversely affect survival. “

Professor Freddie Hamdi, University of Oxford

The trial, conducted at nine centers in the UK, is the longest study of its kind. This is the first time to fully evaluate his three main treatment options: active monitoring, surgery (radical prostatectomy), and hormonal radiotherapy for men with localized prostate cancer.

Between 1999 and 2009, 1,643 men aged 50 to 69 years across the UK were diagnosed with localized prostate cancer after a PSA blood test, undergoing active monitoring (545), radical prostatectomy ( 553), or agreed to be randomized to definitive radiation therapy (545). ). The research team followed men for an average of 15 years to measure the effects of treatment on mortality, cancer progression and spread, and quality of life.

They found that about 97% of men diagnosed with prostate cancer survived 15 years after diagnosis, regardless of which treatment they received. About a quarter of men who were actively monitored had not received invasive cancer treatment after 15 years.

Patients in all three groups reported similar overall quality of life with respect to general mental and physical health. was found to last much longer than previously thought.

In previous findings published in 2016, researchers found that after 10 years of follow-up, men whose cancer was actively monitored were more likely to progress or metastasize than men in other groups. found that sex was twice as high. It was assumed that this might lead to decreased survival in men with active monitoring over a long period of time. However, after 15 years of follow-up The results of the study indicate instead that survival rates remain similarly high in all groups.

Professor Freddie Hamdy says: Not necessary and can be harmful. ”

“It has also become clear that a small group of men with progressive disease do not benefit from current therapies, no matter how early they are applied.The ability to identify and treat these cases. We need to improve both.”

Co-investigator Professor Jenny Donovan of the University of Bristol said: All three options should be considered when making treatment decisions. This is common to all three options. Men diagnosed with localized prostate cancer are now able to use their own values ​​and priorities when making difficult decisions about which treatment to choose. ”

The trial also highlighted deficiencies in current methods of predicting which prostate cancers are likely to grow rapidly and spread. Initially, every person recruited to the trial had a diagnosis of localized cancer, and 77% of them were considered low risk. Reassessment using more modern methods showed that far more people were considered intermediate risk, and in about 30% of men the disease had already spread beyond the prostate. This means that study participants had higher grades and stages than originally thought. Despite this finding, mortality remained low even when men with intermediate disease delayed treatment or did not receive definitive treatment. It has a low rating, which researchers highlight as a concern.

Professor Peter Albers, Executive Director of the EAU Scientific Council and Urologist at the University of Düsseldorf, said: Today’s active monitoring and biopsy protocols are far more advanced than they were when this trial was conducted, so we may be able to further improve these results. is an important message for patients… and effective. ”

“But it’s also clear that we still don’t know enough about the biology of the disease to determine which cancers are the most aggressive, and further research on this is urgently needed.”