Localized prostate cancer 10-year death rate higher with active monitoring

  • Neal DE & et al.
  • Eur Urol
  • 23 Nov 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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  • Patients with localized prostate cancer managed with active monitoring show higher rates of 10-year cancer-specific mortality (CSM) and lower rates of patient-reported harms vs those receiving radical treatment.
  • Overall cancer-related deaths were low irrespective of treatment.

Why this matters

  • Further follow-up of these patients will clarify risk-benefit ratios of different treatment approaches that need to be weighed when choosing treatment.

Study design

  • Exploratory analyses of 1643 patients with clinically localized prostate cancer who were randomly assigned to active monitoring, radical prostatectomy, or radiotherapy (ProtecT trial), and 997 patients who declined randomization and chose treatment.
  • Funding: None.

Key results

  • At 10 years, 1.8% of patients who received active monitoring died vs 0.67% with surgery and 0.73% with radiotherapy.
  • CSM was significantly lower with radical treatment vs active monitoring:
    • Active monitoring cohort: HR, 0.34 (95% CI, 0.13-0.94).
    • Treatment choice cohort: HR, 0.27 (95% CI, 0.08-0.91).
    • Pooled analysis: HR, 0.31 (P=.003).
  • Urinary incontinence increased postsurgery vs active monitoring and radiotherapy (21% vs 7.0% and 2.3%; P<.001>
  • 35% of patients receiving active monitoring reported firm erections vs 29% in the radiotherapy group and 15% in the surgery group (P<.001>
  • 5.9% of patients reported bloody stools with radiotherapy vs 1.6% with surgery and 1.1% with active monitoring (P<.001>


  • Selection bias.

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