Regardless of the treatment chosen, men with localized prostate cancer had low mortality and similar outcomes after a median of 15 years of follow-up, researchers report. “Radical treatment resulted in a lower risk of disease progression than active monitoring but did not lower prostate cancer mortality,” writes the group. “Even though the active-monitoring protocol was perceived as less intensive than contemporary active surveillance, one quarter of the men in the active-monitoring group were alive without having received any form of treatment. Longer-term follow-up to 20 years and beyond will be crucial to continue to evaluate possible differential effects of various treatments.”
In 82,429 men aged 50-69 years, prostate cancer was diagnosed in 2,664 people. Of those, 1,643 men were enrolled in a study of active monitoring, prostatectomy, or radiotherapy. “Death from any cause occurred in 356 men (21.7%), with similar numbers in all three groups,” the authors report. “Metastases developed in 51 men (9.4%) in the active-monitoring group, in 26 (4.7%) in the prostatectomy group, and in 27 (5.0%) in the radiotherapy group. Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively; clinical progression occurred in 141 men (25.9%), 58 (10.5%), and 60 (11.0%), respectively. In the active-monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. No differential effects on cancer-specific mortality were noted in relation to the baseline PSA level, tumor stage or grade, or risk-stratification score. No treatment complications were reported after the 10-year analysis.”