brand logo

Am Fam Physician. 2023;108(4):406

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)


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.

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.