Ten-year mortality rates of prostate cancer are low, regardless of whether patients are treated with radiotherapy, surgery, or undergo only active surveillance, according to a study published in The New England Journal of Medicine.1
Recent studies give conflicting recommendations for whether there should be population-wide screening for prostate cancer using prostate-specific antigen (PSA) testing. PSA testing can help detect prostate cancer early, but it can also lead to overtreatment and adverse events.
Researchers enrolled 2664 patients diagnosed with prostate cancer to determine whether surgery, radiotherapy, or active surveillance was most beneficial for balancing overtreatment and mortality. Of enrolled patients, 1643 agreed to treatment randomization; 553 underwent prostatectomy, 545 received radiotherapy, and 545 underwent active surveillance.
Prostate cancer-specific survival was nearly 100% for all 3 groups. Disease progression was, however, nearly twice as high for those who underwent active surveillance only. For patients of at least 65 years, there were 7 prostate cancer-related deaths in the surveillance group, 2 in the surgery group, and 3 in the radiotherapy group.
The researchers estimate that for every 9 patients treated with either surgery or radiotherapy, 1 patient would avoid disease progression.
One important study limitation was the significant technological improvements and new treatment options available since the trial began.
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The authors conclude that prostate cancer-related mortality is low, regardless of treatment. Nearly half of patients who underwent active surveillance only, however, avoided treatment altogether. Patients and oncologists should discuss each case to determine whether prostate cancer should be treated.
- 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]