No difference in watch, remove or radiate approach to prostate cancer

A large 10-year UK study of men with localised prostate cancer has shown no significant difference between active monitoring, radical prostatectomy and radical radiotherapy – but the active interventions were associated with more side-effects. 

In the study carried out between 2001 and 2009, 82 429 men were PSA tested and 2664 diagnosed with localised prostate cancer. 1643 were randomised to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545).

At 10-year follow up there were no statistically significant differences between the groups for 17 prostate cancer-specific (p=0.48) and 169 all-cause (p=0.87) deaths. Eight men died of prostate cancer in the active monitoring group; five died of prostate cancer in the radical prostatectomy group and four died of prostate cancer in the radical radiotherapy group.

More men developed metastases in the active monitoring group (33) than in the radical prostatectomy (13) and radical radiotherapy (16) groups. There were higher rates of disease progression in the active monitoring group compared to the active intervention groups.

Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy’s impact on sexual function was greatest at six months, but recovered in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at six months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at six months but recovered.

According to the authors radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with an added burden of side-effects. Further work is needed to follow up participants at 15 years, they say.

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