ProtecT: 10-year outcomes after monitoring, surgery or radiotherapy for localised prostate cancer
In the only randomised trial to compare active monitoring, surgery and radiotherapy for PSA-detected localised prostate cancer, deaths from prostate cancer were rare and equal at ten years in all three groups, though monitoring led to more metastases and progression.
Overview
Phase 3 trial of 1,643 men with PSA-detected localised prostate cancer randomised to active monitoring, radical prostatectomy or radiotherapy with six months of androgen deprivation.
Prostate cancer-specific mortality at ten years was about 1 percent in every group (17 deaths in total), while metastases (6.3 versus 2.4 and 3.0 per 1,000 person-years) and clinical progression were more frequent with monitoring; patient-reported outcomes showed distinct side-effect patterns for each treatment.
- Prostate cancer-specific mortality about 1 percent at ten years in all groups.
- Metastases 6.3 per 1,000 person-years with monitoring vs 2.4 (surgery) and 3.0 (radiotherapy).
Most men with low- and favourable intermediate-risk prostate cancer can safely choose monitoring, and treatment choice should weigh urinary, sexual and bowel side effects against a small difference in progression.
- Most men had low-risk disease; about 20 percent were intermediate or high risk.
- Active monitoring was less intensive than modern active surveillance with MRI.
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