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Fifteen years on, ProtecT still found no difference in prostate cancer deaths between monitoring, surgery and radiotherapy, with about 97 percent of men alive from their cancer in every group, confirming that many men can defer or avoid treatment.
Fifteen-year follow-up of the 1,643 men randomised in ProtecT to active monitoring, prostatectomy or radiotherapy.
Prostate cancer-specific mortality was 3.1 percent with monitoring, 2.2 percent with surgery and 2.9 percent with radiotherapy (no significant difference); metastases occurred in 9.4, 4.7 and 5.0 percent respectively; about a quarter of men in the monitoring group remained untreated at 15 years.
Long-term data support active surveillance as a safe choice for low and much intermediate-risk disease, while the lower metastasis rate with treatment informs the discussion for men with longer life expectancy.
The clearest evidence that radical treatment of localised prostate cancer saves lives when the cancer was found clinically rather than by a blood test, and the clearest single statement of what grade does: a Gleason score above 7 carried ten times the risk of death of a score of 6 or lower in the same trial.
The current shape of the screening question in the United States, and the best short statement of the trade-off in numbers a man can weigh. The three-to-one ratio between metastatic cases prevented and deaths prevented is also the argument for using metastatic presentation, not mortality, to judge a screening programme sooner.
The trial that made observation a defensible choice for low-risk prostate cancer found by a blood test, and that supplied the number a man needs when weighing surgery: the progression it prevents is mostly progression on a scan or a blood test, and the harms it causes are felt every day.
Shares SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up, PIVOT: follow-up of prostatectomy versus observation for early prostate cancer, ProtecT, Localised prostate cancer, very low and low risk.
Shares SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch.
Shares ProtecT, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Prostate cancer.
Shares PIVOT: follow-up of prostatectomy versus observation for early prostate cancer, Localised prostate cancer, very low and low risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, Prostate cancer.
Shares SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up, PIVOT: follow-up of prostatectomy versus observation for early prostate cancer, USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Localised prostate cancer, very low and low risk.
Shares ProtecT, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Prostate cancer.
Shares SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up, PIVOT: follow-up of prostatectomy versus observation for early prostate cancer, USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Localised prostate cancer, very low and low risk.
Shares Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch, New England Journal of Medicine.