Aggressive Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer Outcomes at 15 Years in the UK ProtecT Trial


Matthew Stenger

Posted: 2023/03/21 9:39:00 AM

Last update: Mar 21, 2023 8:41:30 AM

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as reported in New England Journal of Medicine To Freddie C. Hamdy, FRCS (Urol), FMedSciand colleagues, a 15-year follow-up of the UK phase III ProtecT trial showed no significant difference in prostate cancer mortality with active monitoring, surgery, or radiotherapy for patients with localized prostate cancer. yeah.

Survey details

In this study, 1,643 men with localized prostate cancer were enrolled in active monitoring (n = 545), prostatectomy (n = 553), or radiotherapy (n = 545). assigned randomly. With modern risk stratification, 24.1% of patients had intermediate-risk disease and 9.6% had high-risk disease. The primary endpoint was death from prostate cancer.

Main findings

Median follow-up was 15 years (range = 11–21 years).

Prostate cancer deaths occurred in 45 patients (2.7%) across the population, including 17 (3.1%) in the active monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the prostatectomy group. ) were in the radiotherapy group. (whole P. = .53). At 10 and 15 years of follow-up, prostate cancer survival was 98.7% and 96.6% in the active monitoring group, 99.0% and 97.2% in the prostatectomy group, and 99.4% and 97.7% in the radiotherapy group, respectively. bottom. .

Freddie C. Hamdy, FRCS (Urol), FMedSci

Freddie C. Hamdy, FRCS (Urol), FMedSci

All-cause mortality occurred in 356 patients (21.7%) overall, including 124 (22.8%) in the active monitoring group, 117 (21.2%) in the prostatectomy group, and 115 (21.1%) in the prostatectomy group. was in the radiotherapy group.

Overall, metastasis occurred in 104 patients (6.3%), of whom 51 (9.4%) in the active monitoring group, 26 (4.7%) in the prostatectomy group, and 27 (5.0%) in the radiotherapy group Met.

Long-term androgen deprivation therapy was initiated in a total of 151 patients (9.2%), including 69 (12.7%) in the active monitoring group, 40 (7.2%) in the prostatectomy group, and 42 (7.7%) in the prostatectomy group. ) was radiotherapy. group.

Local progression was observed in 259 patients (15.8%) overall, 141 (25.9%) in the active monitoring group, 58 (10.5%) in the prostatectomy group, and 60 (11.0%) in the radiation therapy group. was a group.

In the active monitoring group, 133 patients (24.4%) were alive without prostate cancer treatment at the end of follow-up.

No effect on prostate cancer-specific mortality was observed according to baseline prostate-specific antigen levels, tumor stage or grade, or risk-stratification scores.

The investigators concluded, “After 15 years of follow-up, prostate cancer-specific mortality was low regardless of the treatment assigned. It involves weighing the trade-offs between benefits and harms associated with

Dr. Hamdy of the Nuffield Department of Surgery, University of Oxford, said: New England Journal of Medicine article.

Disclosure: This study was funded by the National Institutes of Health. For full study author disclosures, visit nejm.org.

The content of this post has not been reviewed by the American Society of Clinical Oncology (ASCO®) and does not necessarily reflect the views or opinions of ASCO®.




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