Monitoring prostate cancer may be just as good as treating it

    15 September 2016

    The three main treatment options for prostate cancer are equally effective, according to research published in the New England Journal of Medicine.

    The study found that active monitoring, surgery (radical prostatectomy) and radiotherapy result in similar (and very low) rates of death from prostate cancer. Surgery and radiotherapy reduce the risk of cancer progression over time compared with active monitoring.

    Between 1999 and 2009, 1,643 men between the ages of 50 and 69 agreed to be monitored while they underwent either active monitoring, radical prostatectomy or radical radiotherapy. The research team measured mortality rates at 10 years, cancer progression and spread, and the impact of treatments reported by men.

    They found that survival from localised prostate cancer was approximately 99 per cent, regardless of the type of treatment received. The rate of cancer progression and spread was reduced by more than half in men in the surgery and radiotherapy groups. Cancer progression occurred in one in five in the active monitoring group, as opposed to less than one in 10 in the surgery and radiotherapy groups. However, surgery and radiotherapy caused unpleasant side effects, particularly in the first year after treatment.

    The trial, by the Universities of Oxford and Bristol, is the first to evaluate the effectiveness, cost-effectiveness and acceptability of the three major treatment options for men with localised prostate cancer.

    The study’s chief investigator, Professor Freddie Hamdy, said: ‘What we have learnt from this study so far is that prostate cancer detected by PSA blood test grows very slowly, and very few men die of it when followed up over a period of 10 years — around one per cent — irrespective of the treatment assigned. This is considerably lower than anticipated when we started the study.

    ‘However, treating the disease radically when found reduces the number of men who develop spread of prostate cancer, but we do not know yet whether this will make a difference to them living longer or better, and we have been unable to determine reliably which disease is lethal, and which can be left alone.’

    The study’s co-investigator, Professor Jenny Donovan, said: ‘This is the first time radiotherapy, surgery and active monitoring treatments for prostate cancer have been compared directly. The results provide patients and clinicians with detailed information about the effects and impacts of each treatment, so that they can make an informed decision about which treatment to have.

    ‘Each treatment has different impacts and effects, and we need longer follow up to see how those balance out over the next 10 years.’

    Instant analysis
    In recent times there has been a move towards active monitoring of people with prostate cancer, rather than invasive treatments which can cause side effects. People can understandably feel quite anxious about monitoring a condition rather than treating it, and when that condition is something like a cancer diagnosis (which already has its own preconceptions and stigmas) this anxiety can be even greater.

    This study used 1,643 men with prostate cancer diagnoses and randomly assigned them to radiotherapy, surgery, or active monitoring, and did not find a significant difference in 10-year mortality between active monitoring and treatment. However, it did demonstrate that rates of disease progression and metastasis were higher in the active monitoring groups, so it would be interesting to see longer-term data beyond 10 years to assess the significance of those differences.
    Research score: 3/5