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Showed that men with screen-detected prostate cancer die of it rarely, whether monitored or treated, establishing active surveillance.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
ProtecT, trial NCT02044172 sponsored by the UK National Institute for Health Research through Oxford and Bristol, showed that men with PSA-detected localised prostate cancer rarely die of it over fifteen years whether monitored, operated on or irradiated, and it established active surveillance as a legitimate choice. It randomised 1,643 men to active monitoring, prostatectomy or radiotherapy; at fifteen years prostate cancer mortality was low and not significantly different between arms, treatment roughly halved metastasis at the cost of side effects, and about sixty percent of monitored men were eventually treated. OnCo links it to active surveillance, MRI-first screening, Freddie C. Hamdy and the bottleneck of overdiagnosis. Whether modern MRI and biomarkers can pick out the minority who need treatment from the start is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,643 randomised.
No significant difference between arms
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Prostate-cancer-specific mortality at 15 yearsprimary | Active monitoring | 545 | 3.1% | - | - | link |
| Prostatectomy | 553 | 2.2% | ||||
| Radiotherapy | 545 | 2.9% | ||||
| Death from prostate cancer at 15 yearsprimary | Active monitoring | 545 | 3.1% | - | 0.53 | link |
| Radical prostatectomy | 553 | 2.2% | ||||
| Radical radiotherapy | 545 | 2.9% | ||||
| Metastases at 15 years | Active monitoring | 545 | 51 men | - | - | link |
| Radical prostatectomy | 553 | 26 men | ||||
| Radical radiotherapy | 545 | 27 men | ||||
| Clinical progression at 15 years | Active monitoring | 545 | 141 men | - | - | link |
| Radical prostatectomy | 553 | 58 men | ||||
| Radical radiotherapy | 545 | 60 men |
A second publication from the ProtecT trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
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.
Most men with low- and favourable intermediate-risk prostate cancer can safely choose monitoring, and treatment choice should weigh urinary, sexual and bowel side effects against a small difference in progression.
Shares ProtecT: 10-year outcomes after monitoring, surgery or radiotherapy for localised prostate cancer, ProtecT: fifteen-year outcomes after monitoring, surgery or radiotherapy for prostate cancer, Radical prostatectomy, Localised prostate cancer, very low and low risk.
Shares ProtecT: 10-year outcomes after monitoring, surgery or radiotherapy for localised prostate cancer, ProtecT: fifteen-year outcomes after monitoring, surgery or radiotherapy for prostate cancer, Radical prostatectomy, Localised prostate cancer, intermediate risk.
Shares SPCG-4 (Scandinavian Prostate Cancer Group Study 4), Focal and tissue-preserving treatment of prostate cancer, Choosing treatment for localised prostate cancer: what each option costs, Active surveillance and observation.
Shares Efficacy and Safety Study of TOOKAD® Soluble for Localised Prostate Cancer Compared to Active Surveillance, Focal and tissue-preserving treatment of prostate cancer, Active surveillance and observation, Active surveillance.
Shares PSA and MRI-first prostate cancer screening, Radical prostatectomy, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk.
Shares Active surveillance and observation, PSA and MRI-first prostate cancer screening, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk.
Shares Focal and tissue-preserving treatment of prostate cancer, PSA and MRI-first prostate cancer screening, Localised prostate cancer, very low and low risk, Overdiagnosis and false alarms.
Shares Radical prostatectomy, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Overdiagnosis and false alarms.