Study Compares Surgery, Radiation, and Active Monitoring to Treat Prostate Cancer

A study of men in the United Kingdom with early-stage prostate cancer found they were just as likely to survive 10 years whether they had surgery, radiation, or active monitoring – which meant closely watching their disease for any changes and giving them active treatment only if needed. The findings may help men whose prostate cancer is detected through PSA testing make the difficult choice of how to be treated.

Death from prostate cancer was very low overall in the study, with only 1% of men dying from prostate cancer after 10 years, no matter which treatment group they were in. Men in each treatment group were also about equally likely to die of any cause during the study. But there were differences among the groups:

  • Fewer men (about 2% to 3%) in the surgery and radiation groups had metastasis – meaning their cancer spread to other parts of their body – compared with about 6% of men in the active monitoring group.
  • Men who had surgery or radiation were more likely to have side effects that included bowel, bladder, and sexual problems. Of the men in the active monitoring group, about half did not end up needing treatment during the study, so they were able to avoid these potential side effects.

Otis W. Brawley, MD, chief medical officer of the American Cancer Society, says the study shows that active monitoring is a reasonable option for men diagnosed with localized prostate cancer through PSA screening, especially if they have low- or moderate grade-disease.

“As the authors point out, active surveillance and/or delayed treatment avoids the side effects from treatment in those who do not need treatment, but there is an increased risk of cancer progression and spread, and some symptoms may increase gradually over time.

The American Cancer Society recommends men be informed of the potential risks and potential benefits of prostate cancer screening and treatment before making a decision about whether to be screened. This study will help inform that discussion for men making what is a highly personal, and often difficult choice,” said Brawley.

The study involved about 1,600 men in the United Kingdom aged 50 to 69 who were diagnosed with prostate cancer after having an elevated PSA test result. The men were assigned randomly to get surgery to remove their prostate, external-beam radiation, or active monitoring.

While the results showed no difference in death from prostate cancer among the groups after 10 years of monitoring, it remains to be seen whether differences will show up after a longer follow-up period. This could be especially important for younger men diagnosed with prostate cancer, who could potentially live several more decades after their diagnosis.

The study was published online September 14, 2016 in the New England Journal of Medicine.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. Published online September 14, 2016 in the New England Journal of Medicine. First author Freddie C. Hamdy, FRCS (Urol.), F.Med.Sci, University of Oxford, United Kingdom.

Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. Published online September 14, 2016 in the New England Journal of Medicine. First author Jenny L. Donovan, PhD, F.Med.Sci, University of Bristol, United Kingdom.

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