Active Surveillance for Localized Prostate Cancer: No increased mortality, but higher progression

Active surveillance for localized prostate CA: no increased mortality, but
higher rates of clinical progression (ProtecT)

Clinical Question:
What is the best approach to the management of localized prostate cancer?


Bottom Line:
This landmark study compared active surveillance (AS) with radical prostatectomy or radiation therapy for patients with T1c or T2 prostate cancer. The benefits of AS include avoiding radical therapy in half the patients, with no effect on disease-specific suvival or all-cause survival. The potential harms include a greater risk of metastatic disease
(3 additional cases per 1000 person years, corresponding to 3 additional cases for 100 men followed up for 10 years) and a greater likelihood of clinical progression. An accompanying study (N Engl J Med 2016; 2016;375(15):1425-1437) discusses the effects on quality of life and complications of treatment. (LOE = 1b)

Reference:
Hamdy FC, Donovan JL, Lane JA, et al, for the ProtecT Study Group. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375(15):1415-1424.

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