Clinical Question

What are the benefits and harms of different approaches to the treatment of screen-detected prostate cancer?

Bottom Line

Active surveillance provides a balance of benefits and harms. After 15 years, for every 100 participants, 40 can avoid the need for surgery with no increase in the risk of death, although three to four more develop metastatic disease than in the groups treated initially with surgery or radiation. (Level of Evidence = 1b)

Synopsis

The ProtecT study group conducted a randomized controlled trial in the United Kingdom that, with its initial publication five years ago, provided the best information available on the benefits and harms of surgery, radiation, and active surveillance for men with screen-detected prostate cancer. Of the 2,664 men with localized prostate cancer detected by screening between 1999 and 2009, a remarkable 1,643 agreed to be randomized to prostatectomy, radiotherapy, or active surveillance. With active surveillance, any patient or physician concern or an increase of at least 50% in prostate-specific antigen level prompted a review, further testing as appropriate, and consideration for therapy. The study reported the outcomes for a median of 15 years following enrollment.