Prostate Cancer Treatment Outcomes After 15 Years

In a recent article in The New England Journal of Medicine, researchers presented their analysis of 15 years of follow-up data from men diagnosed with prostate cancer and treated with either active monitoring, surgery, or radiotherapy in a UK trial.

According to the study’s lead author, Freddie Hamdy, FRCS, prostate cancer-specific mortality was low regardless of the treatment received, and so choice of treatment in a patient with localized prostate cancer requires consideration of benefits and risks for each potential therapy.

Prostate Cancer Treatment Outcomes Similar at 15 Years

Researchers used a prostate-specific antigen (PSA) test to screen for prostate cancer among 82,429 men aged 50 to 69 years in the UK. Between 1999 and 2009, a total of 2664 patients were diagnosed with localized prostate cancer, and 1643 were enrolled in a trial to compare active monitoring (n=545), prostatectomy (n=553), and radiotherapy (n=545). Authors noted 1610 (98%) patients completed follow-up.

The primary end point of analysis after a median follow-up of 15 years (range, 11-21) was death due to prostate cancer, and secondary end points included death from any cause, metastases, progression, and long-term androgen-deprivation therapy. The study added more than one third of participants had intermediate- or high-risk disease at time of diagnosis.

Prostate-specific cancer deaths occured in 45 (2.7%) patients overall:17 (3.1%) in the active monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group (P=.53). Researchers reported there were 356 (21.7%) all-cause deaths with a similar rate across all 3 groups.

Metastases occurred in 51 (9.4%) patients in the monitoring group, 26 (4.7%) in the prostatectomy group, and 27 (5.0%) in the radiotherapy group. Additionally, long-term androgen-deprivation therapy was initiated in 69 (12.7%), 40 (7.2%), and 42 (7.7%) patients, and clinical progression occurred in 141 (25.9%), 58 (10.5%), and 60 (11.0%) patients in the monitoring, prostatectomy, and radiotherapy groups, respectively.

“After 15 years of follow-up, prostate cancer–specific mortality was low regardless of the treatment assigned,” the authors summarized. “Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”

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