# ProtecT: fifteen-year outcomes after monitoring, surgery or radiotherapy for prostate cancer

Source: https://onco.cc/key-papers/paper-protect-15-year-nejm-2023/  
OnCo record `paper-protect-15-year-nejm-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Fifteen years on, ProtecT still found no difference in prostate cancer deaths between monitoring, surgery and radiotherapy, with about 97 percent of men alive from their cancer in every group, confirming that many men can defer or avoid treatment.

## Summary

Fifteen-year follow-up of the 1,643 men randomised in ProtecT to active monitoring, prostatectomy or radiotherapy.

Prostate cancer-specific mortality was 3.1 percent with monitoring, 2.2 percent with surgery and 2.9 percent with radiotherapy (no significant difference); metastases occurred in 9.4, 4.7 and 5.0 percent respectively; about a quarter of men in the monitoring group remained untreated at 15 years.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2023
- DOI: 10.1056/NEJMoa2214122
- Authors: Hamdy FC, Donovan JL, Lane JA, et al.
- Findings: Fifteen-year prostate cancer mortality 3.1 percent (monitoring), 2.2 percent (surgery), 2.9 percent (radiotherapy).; Metastatic disease 9.4 percent vs 4.7 percent vs 5.0 percent.
- What it means: Long-term data support active surveillance as a safe choice for low and much intermediate-risk disease, while the lower metastasis rate with treatment informs the discussion for men with longer life expectancy.
- Caveats: Trial design predates MRI-based diagnosis and modern surveillance protocols.

## Sources

- N Engl J Med 2023: https://doi.org/10.1056/NEJMoa2214122
- PubMed: https://pubmed.ncbi.nlm.nih.gov/36912538/

## Connected records

- cancers: [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/)
- trials: [ProtecT](https://onco.cc/trials/protect/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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