Prostate cancer trial surprises the experts
MEN with prostate cancer may not need surgery or radiotherapy to improve their chances of survival, a pioneering new trial has revealed.
The study, known as ProtecT, found that “active monitoring” of patients, where no treatment is given, is just as effective when it comes to 10-year survival rates from the condition.
Between 1999 and 2009 some 1,643 men diagnosed with localised prostate cancer agreed to be a part of the trial.
They were divided at random into three treatment groups: active monitoring (545), surgery (553), or radiotherapy (545).
Active monitoring involves a patient being watched closely by the team running the trial and being seen regularly to check their progress.
The research team measured death rates at 10 years, cancer progression and spread, and the impact of treatments reported by men.
The results, published in two papers in the New England Journal of Medicine, show that all three treatments result in similar, and very low, rates of death from prostate cancer at 10 years.
But the cancer spread was more severe in those who underwent active monitoring as opposed to the other two treatments.
The Wales Cancer Research Centre, hosted by Cardiff University, played an integral part in the study, which was the UK’s largest trial of treatment for prostate cancer.
Professor Howard Kynaston, the Professor of Urological Surgery for Cardiff and Vale University Health Board said: “Survival at the end of the 10-year period was very high.
“A total of 99% of the men survived their prostate cancer irrespective of the treatment group they were allocated to.
“This is a much higher survival rate than we had expected and could mean that in the future many patients with early prostate cancer won’t have to immediately undergo potentially harmful treatment for their disease.
“This could mean significant savings for the NHS and a better standard of life for men with the disease.”
Experts say surgery and radiotherapy reduce the risk of cancer progression over time compared with active monitoring but can cause more unpleasant side effects.
These include urination problems, difficulties in their sex life, and bowel problems.
The rate of cancer progression and spread in the two immediate treatment arms was less than half that of the men who underwent active monitoring.
Cancer progression occurred in one in five in the active monitoring group as opposed to less than one in 10 in the surgery and radiotherapy groups. Wales-based researchers played several leading roles in the UK-wide trial.
Prof Kynaston played a leading role in developing the active monitoring protocol while Professor Malcolm Mason was the lead oncologist and Dr John Staffurth co-ordinated the radiotherapy quality assurance.
This is the first time that radiotherapy, surgery and active monitoring treatments have been directly compared for prostate cancer.
Longer follow-up is needed to determine the “trade-off” that patients need to make between cancer outcomes and quality of life.