The ProtecT trial (UK) randomized men with localized prostate cancer (PSA-detected) to active monitoring, radical prostatectomy, or radical radiotherapy. Which was the primary outcome finding at 10-year follow-up?

• A Prostate cancer-specific mortality was low and not significantly different between the three groups ✓
• B Radical prostatectomy had significantly lower prostate cancer-specific mortality than active monitoring
• C Radical radiotherapy had the highest rate of biochemical failure
• D Active monitoring led to a significantly higher rate of metastatic disease than radical treatments

Explanation

The ProtecT trial's landmark 10-year follow-up (published 2016, 15-year follow-up 2023) showed that prostate cancer-specific mortality was very low (<3% in each arm) and not significantly different between active monitoring, radical prostatectomy, and radical radiotherapy for PSA-detected localized prostate cancer. While metastatic disease was higher in the active monitoring group at 10 years, the difference in cancer mortality was not statistically significant. This established that for low-to-intermediate risk localized prostate cancer, all three approaches offer excellent cancer control, and quality of life differences (incontinence, erectile dysfunction for surgery; bowel symptoms for radiotherapy) should guide decision-making alongside patient preference.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.