Prostate cancer: treat or observe?
English specialists from 9 clinics, led by researchers from the Universities of Oxford and Bristol, conducted the first of its kind ProtecT clinical study, which assessed the effectiveness, economic feasibility and acceptability of three main treatment options for localized (non-metastatic) prostate cancer: active monitoring, surgical intervention (radical prostatectomy) and radiotherapy
As part of the study, between 1999 and 2009, 82,429 men aged 50-69 years were examined, while 1,643 of them were diagnosed with localized prostate cancer. These patients were randomly divided into three groups depending on the therapy option used: an active monitoring group (545), a radical prostatectomy group (553) or radical radiotherapy (545). The authors analyzed 10-year mortality, the progression and spread of cancer, and the effects of therapy noted by the men themselves.
Processing of the collected data showed that surgery and radiotherapy reduced the rate of cancer progression and spread by more than half compared to the active monitoring group. Cancer progression was recorded in every fifth (20%) of the active monitoring group, while in the other two groups this indicator was less than 10%. At the same time, surgery and radiotherapy caused adverse side effects, especially during the first year after treatment.
After two to three years, patients partially recovered from side effects, but even 6 years after the therapy, twice as many men in the surgical intervention group experienced problems such as urinary incontinence and sexual dysfunction compared to patients in the active monitoring and radiotherapy groups. On the other hand, radiotherapy caused more problems from the gastrointestinal tract than surgery and active monitoring.
At the same time, the 10-year survival rate of patients in all three groups was very high and amounted to approximately 99% regardless of the type of therapy; none of the treatment methods as a whole at any stage of the study had an impact on other indicators of quality of life, including did not cause anxiety and depression.
The head of the study, Professor Freddie Hamdy from Oxford University, notes that the data obtained to date indicate that localized prostate cancer detected during a blood test for prostate–specific antigen (PSA) develops very slowly and only a few men – about 1% - die during the 10-year follow-up period, regardless of the chosen method of therapy. At the same time, radical treatment of the disease reduces the number of patients who have the spread of the tumor. However, today it is unclear whether this improves the indicators of life expectancy or quality of life. In addition, the authors failed to develop a method for determining which tumors are lethal and which can be left untreated.
In order to clarify this issue, as well as to determine the compromise between the manifestations of the disease and the quality of life that patients should go to, it is necessary to conduct further studies, as well as increase the follow-up period.
Articles by Freddie C. Hamdy et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer and Jenny L. Donovan et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer is published in the New England Journal of Medicine.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on the materials of Universities of Oxford: Largest UK trial of treatment for prostate cancer publishes first results.
21.09.2016