A Publication of Dr. William J. Catalona The ProtecT Trial: Q uest Winter 2016 • Volume 24, Number 3 and the Urological Research Foundation for either active monitoring, surgery, or radiation therapy (545, 553, and 545 men respectively). The Long-term trials can provide a distinct perspective median age was 62 on critical issues in clinical care. years, and the median compared to 46 men each in the surgery PSA level was 4.6 ng/ml. and radiation therapy groups. Study results Metastatic disease was defined as At a median of 10 years follow-up, bony, soft tissue, or lymph-node prostate-cancer-specific death was low metastases on imaging or PSA levels (1%) across all treatment groups. This above 100 ng/ml. Patients were was even lower than the researchers considered to have disease progression had expected. Only 17 men died from if they had evidence of metastases, prostate cancer, 8 in the active diagnoses of clinical stage T3 or T4 monitoring group, 5 in the surgery disease, long-term androgen-group, and 4 in the radiation therapy deprivation therapy (ADT, or hormone group. All-cause mortality was also low therapy), ureteric obstruction, rectal at approximately 10%. fistula, or the need for a urinary However, rates of disease catheter due to local tumor growth. progression and metastatic disease were Primary treatment failure significantly higher in the active At the end of the reported follow-up, monitoring group than in the surgery or 85% of the men in the radiation therapy radiation groups. Thirty-three men in the or surgery groups had received a “radical active monitoring group developed intervention,” defined as radical metastatic disease, compared to 13 men prostatectomy, radiation therapy, or high-in the surgery group and 16 men in the intensity focused ultrasound therapy. radiation group. In the active monitoring (continued on page 2.) group, 112 men had disease progression, ©Dan Oldfield Comparing Surgery, Radiation and Surveillance for Localized Prostate Cancer at 10 Years Follow-Up The latest results from the ProtecT trial, a large UK-based randomized study, compared radical prostatectomy, external beam radiation therapy, and active monitoring for patients who had PSA testing and were diagnosed with localized prostate cancer. The study focused on the rates of men who died from prostate cancer, developed metastatic prostate cancer or had disease progression in each type of treatment. S ince the advent of PSA testing, there has been a dramatic increase in the diagnosis and treatment of prostate cancer. However, PSA testing remains controversial due to concerns about overtreating tumors that would never cause harm and side effects of treatment, such as urinary or sexual dysfunction. The ProtecT trial was designed to improve clinical outcomes in men with PSA-detected clinically localized prostate cancer. In the study, a total of 82,429 men ages 50 to 69 years received a PSA test from 1999 to 2009. Of the 2,664 men diagnosed with prostate cancer, 62% (1,643 men) agreed to be randomized into groups T he URF appreciates your support. Our mission is to advance research and education for the prevention, detection, treatment and cure of prostate cancer.
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