A recent study published in the New England Journal of Medicine examined 15-year outcomes in men with localized prostate cancer treated with active monitoring, surgery or radiation therapy.
The study was conducted in the UK and involved a total of 1,643 men aged 50-69. The primary outcome variable was the number of prostate cancer deaths. Secondary outcomes were death from other causes, disease progression, initiation of long-term androgen inhibitory therapy, and metastasis.
There were a total of 45 deaths believed to be caused by prostate cancer, of which 17 (3.1 percent) were in the active monitoring group, 12 (2.2 percent) in the prostatectomy group, and 16 (2.9 percent ) in the radiotherapy group. Prostate-specific mortality at 15 years was approximately the same regardless of the treatment patients received, and there was no statistically significant difference between groups. The researchers noted that radical treatment (prostatectomy or radiation therapy) reduced the risk of metastasis and local progression and the risk of long-term androgen deprivation therapy by 50 percent compared to active monitoring. However, these reductions did not result in a difference in mortality at the 15-year follow-up.
Furthermore, there were differences between the groups in side effects that the patients experienced after treatment. The researchers saw that the quality of life was lower in the participants in the groups that underwent surgery or radiation. The men in these two groups also reported poorer sexual function, more urinary tract problems, and more general psychological problems.
The results of this study show that patients had a low risk of dying from their prostate cancer at the 15-year follow-up, regardless of the treatment they received. For example, radical treatment may yield benefits in the form of reduced risk of long-term androgen deprivation treatment. The researchers point out that it is important for doctors to carefully weigh the benefits and risks together with the patient when choosing a treatment method for localized prostate cancer.
The medical journal 22-23/2023
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