10-year follow-up: Localized prostate cancer treatments offer similar efficacy

As both groups of researchers noted, longer follow-up is needed to definitively assess outcomes in the Protect trial. For now, however, we can conclude that active monitoring leads to increased metastasis, compared with either surgery or radiotherapy.

So if a man wants to avoid metastatic prostate cancer and the adverse effects of its treatment, active monitoring should be considered only if he has life-shortening, coexisting disease and his life expectancy is less than the 10-year median follow-up of this study.

Men who have low- or intermediate-risk prostate cancer should feel free to select either surgery or radiotherapy on the basis of the treatments’ QOL profiles, since the mortality profiles are equivalent.

Anthony V. D’Amico, MD, is in the department of radiation oncology at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, both in Boston. He reported having no relevant financial disclosures. Dr. D’Amico made these remarks in an editorial accompanying the two reports on the Protect trial (N Engl J Med. 2016 Sep 14. doi: 10.1056/NEHMe1610395).