Disease-specific mortality rates for men with prostate cancer are comparable for 3 treatment options: active surveillance, radical prostatectomy, and external-beam radiotherapy, a study published in The New England Journal of Medicine has shown.1
Because the effectiveness of treatment options for prostate cancer detected via prostate-specific antigen (PSA) testing, as compared to each other, was uncertain, researchers sought to compare disease-specific mortality rates for active surveillance, radical prostatectomy, and external-beam radiotherapy for clinically localized prostate cancer.
A total of 82,429 men age 50 to 69 years in the United Kingdom were recruited by the Prostate Testing for Cancer and Treatment (ProtecT) trial to undergo PSA testing between 1999 and 2009. Of the 2664 men who received a diagnosis of localized prostate cancer, 1643 agreed to participate in the study. Participants were randomized to active surveillance (545 men), radical prostatectomy (553 men), and external-beam radiotherapy (545 men). Primary outcome was prostate cancer–specific mortality at a median 10 years follow-up; secondary outcomes were disease progression rates, metastases, and all-cause deaths.
Overall, 17 participants died of prostate cancer–specific causes: 8 men in the active surveillance group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7-3.0), 5 men in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4-2.2), and 4 men in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3-2.0).
For the overall comparison, no significant difference was seen in prostate cancer–specific deaths among the 3 treatment groups (P =.48 for the overall comparison). Nor was a significant difference seen in deaths from any cause (169 deaths overall; P =.87) among the 3 groups.
In the active surveillance group, 33 men developed metastases (6.3 events per 1000 person-years; 95% CI, 4.5-8.8), which was more than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4-4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9-4.9) (P =.004 for the overall comparison). Rates of disease progression were also higher in the active surveillance group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0-27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7-11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7-12.0) (P <.001 for the overall comparison).
At a median of 10 years, the researchers found prostate cancer–specific mortality rates were low for all 3 treatment options, with no significant difference among them. Incidences of both disease progression and metastases were lower in the surgery and radiotherapy groups compared with the active surveillance group.
This study was funded by the National Institute for Health Research; Current Controlled Trials number, ISRCTN20141297; ClinicalTrials.gov number, NCT02044172.
1. Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016 Sep 14. doi: 10.1056/NEJMoa1606220. [Epub ahead of print]