A 68-year-old man has a PSA of 18 ng/mL and Gleason grade group 4 prostate cancer (Gleason 4+4=8) confined to the prostate on MRI (cT2c). The ProtecT trial compared active surveillance, radical prostatectomy, and radical radiotherapy. Which oncological outcome was significantly different between treatments at 15 years?

• A Prostate cancer-specific mortality was significantly lower with surgery
• B Overall survival was significantly better with radiotherapy
• C No difference in metastasis or prostate cancer mortality between the three groups
• D Prostate cancer-specific mortality was similar between treatments, but metastasis rate was lower with radical treatments ✓

Explanation

The ProtecT trial (15-year follow-up published 2023) showed that prostate cancer-specific mortality remained very low and similar across active surveillance, surgery, and radiotherapy arms (~3%). However, the metastasis rate was significantly higher in the active monitoring arm (9.4%) compared to surgery (4.7%) and radiotherapy (5.0%). No difference in overall mortality was detected. This trial supports that for men with localized prostate cancer, all three approaches offer similar low cancer-specific mortality, but active surveillance carries a higher metastasis risk, particularly important for higher-grade disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.