Prostate Cancer Decision Tool

Understanding the outcomes of the different treatments for localised prostate cancer can be challenging.

It’s a personal choice weighing up the quality of life versus the survival benefits.

The following diagram are the average results from the Protect Study for each of the three treatment options- active surveillance, radical prostatectomy, and radiotherapy.

Protect Study

Off course every patient is different, and some patients may be at higher or lower risk than that indicated, however none of the small survival differences at 15 years are statistically proven for the whole group of patients or any particular risk group.

There are many different measures of quality of life. The quality of life is shown at 5 years. In subsequent years there are changes due to natural ageing and some patients who started with active surveillance may end up undergoing radical prostatectomy or radiotherapy which can impact on quality of life.

Incontinence was defined as not being 100% continent.

Erectile dysfunction was defined as erections not being firm enough for intercourse.

The outcomes are shown for blocks of a hundred men as a percentage. A green man is a good outcome, and a red man is a bad outcome.

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Q: What is the ProtecT trial?

A:

The ProtecT (Prostate Testing for Cancer and Treatment) trial is a large UK-based randomized controlled study that enrolled 1,643 men with localized prostate cancer. Participants were assigned to one of three groups: active monitoring, radical prostatectomy (surgery), or radiotherapy with hormone therapy. The trial aimed to compare the long-term outcomes of these treatment strategies.

Q: What were the key findings after 15 years?

A:

After a median follow-up of 15 years, prostate cancer–specific mortality was low across all groups: 3.1% in the active monitoring group, 2.2% in the surgery group, and 2.9% in the radiotherapy group. These differences were not statistically significant, indicating that all three approaches had similar long-term survival outcomes.

Q: Were there differences in disease progression and metastasis?

A:

Yes. Men in the active monitoring group experienced higher rates of disease progression and metastasis. Specifically, 9.4% of men in this group developed metastases, compared to 4.7% in the surgery group and 5.0% in the radiotherapy group.

Q: What about the need for additional treatments?

A:

Over the 15-year period, 61% of men in the active monitoring group eventually required definitive treatment, such as surgery or radiotherapy, due to disease progression.

Q: How did treatments affect quality of life?

A:

Quality of life outcomes varied among the groups. Men who underwent surgery reported higher rates of urinary incontinence, while those who received radiotherapy experienced more bowel issues. Sexual function declined across all groups but was most pronounced in the surgery and radiotherapy groups.

Q: What are the clinical implications of these findings?

A:

The ProtecT trial suggests that immediate radical treatment may not be necessary for all men with localized prostate cancer. Active monitoring can be a safe option for many, but it requires careful follow-up due to the higher risk of disease progression. Treatment decisions should be individualized, considering both clinical factors and patient preferences.