Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer

Abstract

Cit a tio n fo r fin al p u blis h e d ve r sio n: H a m dy, F r e d di e C., Do n ov a n, Je n ny L., La n e, J. Ath e n e , M e t c alf e, C h ri s, D avis, Mi c h a el, T u r n er, E m m a L., M a r ti n, Ric h a r d M .

Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit

“…Most of the benefit of PSA testing on prostate cancer mortality would be retained in a comprehensive, risk adapted early detection programme because best evidence suggests screening older men is ineffective,2 men who have negative findings in secondary tests such as MRI or blood markers have extremely low mortality from prostate cancer,54 and conservative management of men with low risk disease does not increase the risk of death from prostate cancer 5556…”

Evaluation of Outcomes Following Focal Ablative Therapy for Treatment of Localized Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-Year Experience

“…Recent data from the ProtecT trial indicate prostate-specific mortality is low after 15 years, regardless of treatment or monitoring. 3 However, today a 65-year-old has an average of 17 additional years of life expectancy, leaving many patients and providers looking for an alternative to watchful waiting. 4 Treatments that minimize the intermediate-and long-term impact on urinary, sexual, and bowel function while reducing local progression, metastasis, and the need for hormonal therapy are attractive.…”

“…The decision to actively treat or commence monitoring in the older patient with a diagnosis of organ-confined prostate cancer is becoming increasingly challenging, especially in the setting of increasing comorbidity. Could focal therapy (FT), with its reduced side effect profile, [1][2][3][4][5] represent an acceptable middle ground between watchful waiting and radical treatment? Over the last 15 years in the UK, FT has been offered in several centers in which special arrangements included the requirement for the maintenance of prospective registries.…”

Editorial Comment

“…Results such as these need to be taken in the context of studies such as the 15-year PROTECT trial update showing that whilst there was no difference in survival between up-front radical treatment and initial active monitoring, approximately 60% of those within the monitoring arm underwent treatment over the surveillance period. 2 These radical treatments, come at a significant impact on quality of life, and recent sobering data from the PACE-A trial 3 and Kings College London 4 (Mac-Askill, AUA 2023) show real-world pad-free rates from radical prostatectomy of 53%-75%. In contrast, pad-free rates from focal ablation consistency approach 95%-100%.…”