Patients with localized prostate cancer have a similar rate of cancer-specific mortality whether they undergo active surveillance, surgery, or radiotherapy, according to research published in The New England Journal of Medicine.
Researchers did find that patients assigned to active monitoring had a higher incidence of disease progression than patients who underwent radical treatment, but this did not lower prostate cancer-specific mortality.
This study included 1643 men in the United Kingdom who were diagnosed with localized prostate cancer from 1999 to 2009 (ClinicalTrials.gov Identifier: NCT02044172). The patients were randomly assigned to receive active monitoring (n=545), prostatectomy (n=553), or radiotherapy (n=545).
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Overall, 77.2% of patients were in Gleason grade group 1, and 76.0% had stage T1c cancer. Most patients had low-risk disease according to CAPRA (71%), D’Amico (66%), and Cambridge (71%) risk stratification systems. Nearly all patients (n=1610) completed follow-up.
At a median follow-up of 15 years, 2.7% of patients had died from prostate cancer, including 3.1% assigned to active monitoring, 2.2% assigned to prostatectomy, and 2.9% assigned to radiotherapy (P =.053).
Death from any cause occurred in 21.7% of patients overall, 16.2% in the active monitoring group, 15.0% in the prostatectomy group, and 15.0% in the radiotherapy group.
The incidence of metastases was 6.3% overall, 9.4% in the surveillance arm, 4.7% in the prostatectomy arm, and 5.0% in the radiotherapy arm. Local progression occurred in 15.8% of all patients, 25.9% of patients assigned to surveillance, 10.5% of those assigned to prostatectomy, and 11.0% of those assigned radiotherapy.
At the end of follow-up, 24.4% of patients assigned to active surveillance were still alive and had not undergone radical treatment or received androgen deprivation therapy.
“Our findings provide evidence that greater awareness of the limitations of current risk-stratification methods and treatment recommendations in guidelines is needed,” the researchers wrote. “Men with newly diagnosed, localized prostate cancer and their clinicians can take the time to carefully consider the trade-offs between harms and benefits of treatments when making management decisions.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. Published online April 27, 2023. doi:10.1056/NEJMoa2214122.
