A recent study based out of the United Kingdom analyzed men who had received a prostate cancer diagnosis during a span of 10 years to determine the effectiveness of different treatment options.
A total of 82,429 men between the ages of 50 and 69 received a prostate-specific antigen (PSA) test between 1999 and 2009, with 2664 men receiving a localized prostate cancer diagnosis. From this group, 1643 patients were enrolled in a trial to analyze the effectiveness of randomly assigned treatments. Of those patients, 545 received active monitoring, 553 underwent prostatectomies, and 545 underwent radiotherapy.
During a median follow-up of 15 years, results of the different treatments were compared with respect to death from prostate cancer, the study’s primary outcome. Secondary outcomes included death from any cause, metastases, disease progression, and initiation of long-term androgen-deprivation therapy (ADT).
Follow-up was completed for 1610 (98%) patients. More than one-third of patients had intermediate or high-risk prostate cancer at the time of diagnosis. Death from prostate cancer occurred in 45 patients (2.7%), including 17 (3.1%) from the active-monitoring group, 12 (2.2%) from the prostatectomy group, and 16 (2.9%) from the radiotherapy group (P=.53 for the overall comparison). Death from any cause occurred in 356 patients (21.7%), with similar rates in each group.
A total of 51 patients (9.4%) developed metastases in the active-monitoring group, as did 26 (4.7%) in the prostatectomy group and 27 (5.0%) in the radiotherapy group. Long-term ADT was initiated in 69 (12.7%), 40 (7.2%), and 42 (7.7%) patients, respectively. Clinical progression occurred in 141 (25.9%), 58 (10.5%), and 60 (11.0%) patients, respectively.
In the active-monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. No differential effects on cancer-specific mortality were seen in relation to the baseline PSA level, tumor stage or grade, or risk-stratification score. No treatment complications were reported after the 10-year analysis.
Results from the 15-year follow-up showed that prostate cancer-specific mortality was low regardless of the treatment assigned. Patients with prostate cancer must weigh the trade-offs between benefits and harms when choosing which therapy to undergo for treatment.