Female doctor asking questions to prostate cancer patient

No need to rush localised prostate cancer treatment, researchers say

Men with localised prostate cancer had the same survival rates regardless of whether they received radiotherapy, surgery or just active monitoring, a new study has revealed.

The research, published in The New England Journal of Medicine, was led by the universities of Oxford and Bristol, with its findings being presented to the European Association of Urology Congress in Italy.

The researchers found that those who were actively monitored and received regular cancer checks were more likely to have their cancer grow or spread, compared to men undergoing surgery or radiotherapy.

Those who had radiotherapy or surgery found that their side effects of incontinence and impotence could persist up to 12 years – much longer than originally thought.

Despite all this, the trial found that 97% of the men taking part survived 15 years after their diagnosis, irrespective of what treatment they received. Study participants from all three groups also reported similar quality of life.

The trial’s Chief Investigator, Professor Freddie Hamdy, said: “This is very good news. Most men with localised prostate cancer are likely to live for a long time, whether or not they receive invasive treatment and whether or not their disease has spread, so a quick decision for treatment is not necessary and could cause harm.

“It’s also now clear that a small group of men with aggressive disease are unable to benefit from any of the current treatments, however early these are given. We need to both improve our ability to identify these cases and our ability to treat them.”

Researchers also discovered some flaws in the current methods of predicting which specific cases of prostate cancer are likely to grow and spread quickly – initially, of all the men recruited to the study, 77% were deemed low risk, but following a reassessment using more modern techniques, a far greater proportion were considered intermediate risk, with approximately 30% of the patients having their cancer spread from the prostate already.

Crucially though, the researchers say their results show treatment decisions for low and intermediate risk localised prostate cancer don’t need to be rushed.

Professor Hamdy added: “It’s clear that, unlike many other cancers, a diagnosis of prostate cancer should not be a cause for panic or rushed decision making. Patients and clinicians can and should take their time to weigh up the benefits and possible harms of different treatments in the knowledge that this will not adversely affect their survival.”

The research was funded by the National Institute for Health and Care Research. Read the 15-year outcomes here and the 12-year results here.

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NHE May/June 2024

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