10 years on: Comparing treatment options for localized prostate cancer

This study compared the effectiveness of different treatment options available for localized prostate cancer. Authors reported low rates of prostate cancer-specific mortality across all treatment groups. However, surgery and radiation therapy were associated with a lower rate of disease progression and metastases compared to active surveillance.

Most prostate cancer that is diagnosed is localized (confined to the prostate gland). Surgical removal of the prostate gland and radiation therapy are both common treatments for localized prostate cancer. Advances in recent years have led to these treatments being more efficient and easier to tolerate. For example, external beam radiation therapy (EBRT) involves directing high-energy rays from outside the body at the tumor site to kill cancer cells.

However, since prostate cancer often progresses slowly, some men may benefit from delaying treatment. Active surveillance refers to actively monitoring tumor growth without actually administering treatment. Preventing over-treatment is particularly important for men with shorter life expectancies or with other medical conditions. More studies are needed to compare the effectiveness of different treatment options available for localized prostate cancer.

The aim of this study was to directly compare treatment outcomes following surgery, EBRT, and active surveillance.

1,643 men diagnosed with localized prostate cancer (by blood test) were included in this study. Men were randomly assigned to undergo either active surveillance, surgery, or EBRT. Treatment outcomes were compared over an average period of 10 years.

No significant differences in prostate cancer-specific mortality rates were observed at 10 years. 8 men undergoing active surveillance, 5 men undergoing surgery, and 4 men undergoing EBRT died due to prostate cancer during the study period. Age or cancer markers (such as tumor stage) did not affect this outcome.

20.5% of men undergoing active surveillance showed disease progression. This was significantly higher compared to the surgery group (8.3%) and the EBRT group (8.4%). Cancer spread to other parts of the body (metastases) was observed in 6.1% of men in the active surveillance group. This was significantly higher compared to surgery (2.4%) and EBRT (2.9%).

Authors concluded that death due to prostate cancer was low regardless of treatment received. Surgery and EBRT were associated with a reduced rate of disease progression and metastases.