Top Line: Does immediate treatment reduce long-term prostate cancer mortality compared to active monitoring?
The Study: The ProtecT trial was a landmark study of localized prostate cancer management conducted between 1999 and 2009 in the UK. It screened 82,429 men age 50-69 with PSA and identified 2,664 (3%) with localized prostate cancer. Most (77.2%) had grade group 1 disease. The breakdown of D’Amico risk categories was 66.3% low risk, 24.1% intermediate risk, and 9.6% high risk. They were randomized to active monitoring, prostatectomy, or radiation. At the 10 year mark, there was no difference in prostate cancer specific mortality among groups, however there was a higher rate of disease progression and distant metastasis in the active monitoring group. Here we have the 15 year results of ProtecT. Again, there was no significant difference in the rate of prostate cancer mortality among active monitoring (3.1%), prostatectomy (2.2%), or radiation (2.9%). To put prostate cancer in perspective, the overall mortality rate was 21.7% and 83.4% of those were from either cardiorespiratory disease (31.8%) or another cancer (51.6%). By 15 years, 61.1% of those in the active monitoring group received definitive treatment. The rate of metastasis was higher in the active monitoring group (9.4%) compared to prostatectomy (4.7%) and radiation (5.0%). Just over a quarter (27.4%) of the metastases in the active monitoring group were nodal mets.
TBL: 15 year outcomes from the ProtecT trial show that there is no difference in prostate cancer mortality among active monitoring, prostatectomy, and radiation for patients with mostly low and intermediate risk disease. By 15 years, 61.1% of active monitoring patients received definitive treatment, but that group had nearly double the risk of developing metastasis (9.4%). | Hamdy, N Engl J Med 2023
The Study: The ProtecT trial was a landmark study of localized prostate cancer management conducted between 1999 and 2009 in the UK. It screened 82,429 men age 50-69 with PSA and identified 2,664 (3%) with localized prostate cancer. Most (77.2%) had grade group 1 disease. The breakdown of D’Amico risk categories was 66.3% low risk, 24.1% intermediate risk, and 9.6% high risk. They were randomized to active monitoring, prostatectomy, or radiation. At the 10 year mark, there was no difference in prostate cancer specific mortality among groups, however there was a higher rate of disease progression and distant metastasis in the active monitoring group. Here we have the 15 year results of ProtecT. Again, there was no significant difference in the rate of prostate cancer mortality among active monitoring (3.1%), prostatectomy (2.2%), or radiation (2.9%). To put prostate cancer in perspective, the overall mortality rate was 21.7% and 83.4% of those were from either cardiorespiratory disease (31.8%) or another cancer (51.6%). By 15 years, 61.1% of those in the active monitoring group received definitive treatment. The rate of metastasis was higher in the active monitoring group (9.4%) compared to prostatectomy (4.7%) and radiation (5.0%). Just over a quarter (27.4%) of the metastases in the active monitoring group were nodal mets.
TBL: 15 year outcomes from the ProtecT trial show that there is no difference in prostate cancer mortality among active monitoring, prostatectomy, and radiation for patients with mostly low and intermediate risk disease. By 15 years, 61.1% of active monitoring patients received definitive treatment, but that group had nearly double the risk of developing metastasis (9.4%). | Hamdy, N Engl J Med 2023