While survival at 10 years is similar, localized prostate cancer may be more likely to metastasize in men receiving active surveillance compared with those who have surgery or radiation therapy, according to results from a clinical trial published in the New England Journal of Medicine.
A total of 1643 men between the ages of 50 and 69 years were enrolled in the trial and randomly assigned to receive active monitoring (n = 545), surgery (n = 553), or radiotherapy (n = 545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause death.
Overall, investigators found that there was no significant difference in the number of cancer-specific deaths among any of the treatment groups, though more patients died from their disease in the active surveillance group (8 deaths) than in those treated with surgery (5) or radiotherapy (4). There was also no significant difference in all-cause morality.
However, more than double the number of patients developed metastasis in the active surveillance group (33 men) versus the surgery (13) or radiotherapy (16) groups. And patients were more likely to progress while receiving active surveillance (112 men) than when treated with surgery (46) or radiotherapy (46). Still, only about half of patients assigned to receive active surveillance ended up needing radical treatment to manage their disease, meaning that many were spared harsh side effects that often result from treatment.
“At a median follow-up of 10 years, the ProtecT trial showed that mortality from prostate cancer was low, irrespective of treatment assignment,” Authors of the study concluded. “Prostatectomy and radiotherapy were associated with lower rates of disease progression than active monitoring; however, 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.”
The investigators, Freddie C Hamdy, MD, University of Oxford, England, also said that men with newly diagnosed, localized prostate cancer should discuss treatment goals and with their clinician to better understand the critical trade-offs between the short- and long-term effects of radical treatment.
