Management of Localized Prostate Cancer: Data at Last
Mortality was similar with active monitoring, prostatectomy, or radiotherapy during 10 years of follow-up.
Determining a management strategy for men with low-risk, clinically localized prostate cancer identified by prostate-specific antigen (PSA) testing remains a challenge given the paucity of data. To compare three initial approaches for such patients, U.K. investigators randomized 1643 men (median age, 62 years) with localized disease (median PSA, 4.6 ng/mL) to active monitoring (regular PSA testing and curative or palliative intervention with progression), radical prostatectomy, or radiotherapy (3–6 months of androgen-deprivation therapy and 74 Gy).
Of these patients, 76% had clinical stage-T1c disease, and 77% had tumors with a Gleason score of 6. More than 70% of patients received the specified management within 9 months of randomization. Of the 545 men who received active monitoring, 53% ultimately underwent radiotherapy or surgery.
At a median 10 years of follow-up, prostate-specific mortality (the primary outcome) was similar with each strategy: 8 patients died with active monitoring, 5 died with prostatectomy, and 4 died with radiotherapy. The rate of metastasis was higher with active monitoring than with local therapy (P=0.004). The investigators estimated that to avoid having one patient develop metastatic disease, 27 would need to undergo prostatectomy, and 33 would need to receive radiotherapy.