One of the most challenging decisions a man must make after being diagnosed with prostate cancer is what to do. The sheer number of treatment options from invasive surgery to radiation to observation can be daunting to understand. Luckily there is some randomized data to help guide that decision.
The best randomized study is the ProtecT Trial. This study randomized 1643 men with clinically localized prostate cancer to receive active surveillance, radical prostatectomy or radiation therapy. The vast majority of these patients had Gleason 6 disease and were stage T1c.
Those two facts are important as the data is best applied only to men with that pathology and for men with higher risk disease (Gleason 7 or higher or T2 disease, these data may not be applicable).
The good news is that with ten year follow up cancer-specific survival was low among all groups with no significant difference between the three groups. Translation: it doesn’t matter which treatment option you choose! There was a slightly higher incidence of disease progression in the active surveillance group as compared to the other two groups which were similar. On the other hand, the risk of complications from intervention was higher in the surgery group than the other two groups.
Making treatment decisions with a new diagnosis of prostate cancer is challenging; but data like this can help guide patients and their family to reaching a decision.
If you have questions about this study or any other study, please call my office for a visit.