Active monitoring of prostate cancer is associated with the same high survival rates as radiotherapy or surgery, a large UK 15-year study has found.
Findings from the ProtecT trial of 1610 patients with localised prostate cancer found that although men on active monitoring were more likely to see the disease progress or spread than those receiving radiotherapy or surgery, it did not reduce their likelihood of survival.
Presenting the findings at the European Association of Urology (EAU) Congress in Milan, the researchers from the Universities of Bristol and Oxford also found that the negative impacts of radiotherapy and surgery on urinary and sexual function persist for up to 12 years.
Results from the National Institute for Health and Care Research (NIHR) funded trial were also published in the New England Journal of Medicine with researchers concluding ‘prostate cancer–specific mortality was low regardless of the treatment assigned’.
Death from prostate cancer occurred in 45 men – 17 (3.1%) in the active-monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group, they reported.
It suggests that treatment decisions following diagnosis for low and intermediate risk localised prostate cancer do not need to be rushed, lead investigator, Professor Freddie Freddie Hamdy from the University of Oxford said.
‘It’s clear that, unlike many other cancers, a diagnosis of prostate cancer should not be a cause for panic or rushed decision making.
‘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 was done in nine UK centres and is the first to fully evaluate the three major treatment options for localised prostate cancer.
Men aged 50 to 69 years were recruited to the study after being diagnosed with localised prostate cancer following a PSA blood test and were evenly split between the two groups.
In all, regardless of treatment, 97% of men survived for the 15-year study period and around quarter of the men on active monitoring had still not had any invasive treatment for their cancer at this point.
All three groups reported similar overall quality of life, in terms of 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, the researchers said.
Professor Hamdy added: ‘It’s also now clear that a small group of men with aggressive disease are unable to benefit from any of the current treatments, however early these are given. We need to both improve our ability to identify these cases and our ability to treat them.’
Co-investigator, Professor Jenny Donovan, from the University of Bristol, said: ‘Patients and doctors now have the necessary information on the long-lasting side effects of treatments to better understand the trade-offs between their benefits and harms.
‘Now men diagnosed with localised prostate cancer can use their own values and priorities when making the difficult decisions about which treatment to choose.’
Professor Peter Albers, chair of the EAU’s Scientific Congress Office and a urologist at Düsseldorf University, said it was an important message for patients that delaying treatment was safe, especially as that means delaying side effects as well.
‘But it’s also clear that we still don’t know enough about the biology of this disease to determine which cancers will be the most aggressive and more research on this is urgently needed.’
The results comes as a charity said testing for prostate cancer is ‘much less harmful’ than it used to be and the evidence on introducing a PSA screening programme should be reconsidered.
An analysis by Prostate Cancer UK and presented at the American Society of Clinical Oncology meeting in San Francisco has claimed he introduction of MRI before biopsy as well as changes to the way biopsies are done has tipped the seesaw in favour of screening.
A Department of Health and Social Care spokesperson had confirmed that the UK National Screening Committee had received a set of proposals relating to screening for prostate cancer.
‘It will explore these further and consider how best to take them forward.’
