Delaying treatment of localized prostate cancer ‘does not increase the risk of death’

The doctor holds a stethoscope
The doctor holds a stethoscope

Delaying treatment for localized prostate cancer does not increase the risk of death, new research suggests.

According to a new study, active monitoring of the disease has the same high survival rates after 15 years as radiation therapy or surgery.

Men on active follow-up, which involves regular tests to monitor the cancer, were more likely to see it progress or spread than those who had radiation therapy or surgery.

However, this did not reduce their chance of survival, the study suggests.

The trial also found that the negative impacts of radiation therapy and surgery on urinary and sexual function persist much longer than previously thought, for up to 12 years.

The researchers suggest that the findings show that treatment decisions after diagnosis of low- and intermediate-risk localized prostate cancer (cancer within the prostate that has not spread to other parts of the body) need not be rushed.

The latest findings from the ProtecT trial, led by the Universities of Oxford and Bristol, were presented at the European Association of Urology (EAU) Congress in Milan and published in the New England Journal of Medicine.

Lead investigator Professor Freddie Hamdy from the University of Oxford said: “It is clear that, unlike many other types of cancer, a diagnosis of prostate cancer should not be a cause for panic or hasty decision-making.

“Patients and clinicians can and should take time to weigh the benefits and potential harms of different treatments knowing that this will not adversely affect their survival.”

The trial, the first to fully evaluate three main treatment options: active monitoring, surgery (radical prostatectomy) and radiotherapy with hormones for men with localized prostate cancer, was carried out in nine centers in the UK.

Between 1999 and 2009, 1,643 men ages 50 to 69 diagnosed with localized prostate cancer were enrolled in one of three treatment groups.

They were followed for an average of 15 years to measure death rates, the progression and spread of the cancer, and the impact of the treatments on quality of life.

The study found that about 97% of men diagnosed with prostate cancer survived 15 years after diagnosis, regardless of the treatment they received.

After 15 years, about a quarter of those on active follow-up had still not received any invasive treatment.

Men in all three groups reported a similar overall quality of life.

The negative effects of surgery or radiation therapy on urinary, bowel, and sexual function have been found to persist much longer than previously thought.

Research published in 2016 found that after 10 years of follow-up, men whose cancer was being actively monitored were twice as likely to see it progress or metastasize than those in the other groups.

While the assumption had been that this might lead to a lower survival rate for men with active monitoring over a longer period of time, the 15-year follow-up results show that this is not the case.

Professor Hamdy said: “This is very good news.

“Most men with localized prostate cancer are likely to live a long time, whether or not they receive invasive treatment and whether or not their disease has spread, so a quick decision is not necessary for treatment and could cause harm.

“It is also now clear that a small group of men with aggressive disease cannot benefit from any of the current treatments, no matter how early they are given.

“We need to improve both our ability to identify these cases and our ability to treat them.”

Co-investigator Professor Jenny Donovan, from the University of Bristol, said: “Now men diagnosed with localized prostate cancer can use their own values ​​and priorities when making difficult decisions about which treatment to choose.”

The researchers say the new trial also highlighted flaws in current methods for predicting which prostate cancers are likely to grow rapidly and spread.

Initially, all those involved in the trial were diagnosed with localized cancer and 77% of them were considered low risk.

Retesting using newer methods showed that a much larger number would now be considered intermediate risk, and in about 30% of the men, the disease had already spread beyond the prostate.

This means that the men in the study had a higher grade and stage of disease than initially thought.

Some of the men who later died of prostate cancer had been assessed as low risk at the time of diagnosis, which the researchers say is cause for concern.

Professor Peter Albers, president of the EAU’s Scientific Congress Office and a urologist at the University of Dusseldorf, said it was “clear” that not enough is known about the biology of the disease to determine which cancers will be the most aggressive. and that more research is urgently needed. necessary.


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