Is monitoring prostate cancer as effective as treatment?

15^th September 2016 -- A major UK study has found that 99% of men whose prostate cancer is detected at an early stage live for at least 10 years whether the condition is treated or if doctors carry out 'active surveillance'.

Prostate cancer testing

For men in the UK, prostate cancer is the most common cancer. There are more than 40,000 men newly diagnosed every year.

Unlike some other cancers, there is no routine screening of men in the UK for prostate cancer. That's because the screening test, called prostate-specific antigen (PSA), has not been found to be accurate enough. There can be misleading results, meaning men may end up having unnecessary treatment or being concerned about a cancer they don’t have.

Prostate cancer is usually slow developing, meaning it can take some years before men notice any symptoms, such as difficulty urinating.

Because prostate cancer is often slow growing, instead of starting treatment with its side-effects, some men and their doctors decide on close surveillance of their cancer, called active monitoring or active surveillance.

ProtecT study

The New England Journal of Medicine reports on the UK's largest ever prostate cancer treatment trial, called ProtecT.

It compared active monitoring, radical prostatectomy operations and external-beam radiotherapy treatment for prostate cancer that had not spread outside the prostate – called localised prostate cancer.

Between 1999 and 2009, 82,429 men in the study aged 50 to 69 had a PSA test. Of these, 2,664 received a diagnosis of localised prostate cancer.

Of those diagnosed with prostate cancer, 1,643 agreed to be randomly assigned to a treatment or no treatment group.

• 545 had active monitoring
• 553 had surgery
• 545 had radiotherapy.

The men were followed up for around 10 years, or until they died. Rates of cancer progression, the spread of the cancer and deaths from any causes were also recorded.

Overall, 17 men died from their prostate cancer during the 10-year study period – 8 who had active monitoring, 5 who had an operation and 4 who had radiotherapy.

Researchers say these differences were not statistically significant.

However, rates of cancer spreading and disease progression were lower in the men who had operations or radiotherapy.

Reaction

Prostate cancer groups and experts have issued statements commenting on the findings.

Dr Matthew Hobbs, deputy director of research at Prostate Cancer UK, says:

“These results bring good news for men diagnosed with prostate cancer before it has spread outside the prostate. The finding that 99% of men diagnosed at that early stage lived for at least 10 years regardless of their treatment on the trial is hugely positive. However, only about half of the 47,000 men diagnosed with prostate cancer each year in the UK are caught at this early stage and according to the most recent figures only 22% of men diagnosed at the latest stage survive for 10 years. This discrepancy demonstrates why we must do all we can to find more cancers at an early stage by raising awareness of the disease and funding research that will deliver better diagnosis."