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Comparison of active surveillance , radical prostatectomy or radical radiotherapy to people with low - risk localised prostate cancer

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Low-risk localised prostate cancer

  • choice between active surveillance, radical prostatectomy or radical radiotherapy to people with low-risk localised prostate cancer for whom radical treatment is suitable

Factors to consider when discussing active surveillance, radical prostatectomy or radical radiotherapy as treatment options for people with low-risk or intermediate-risk localised prostate cancer, using evidence from a large UK trial

  • What effect does each treatment option have on survival?
    • evidence does not show a difference in the number of deaths from prostate cancer among people offered active surveillance, prostatectomy or radical radiotherapy. People who had not died of prostate cancer were:
      • 98 out of 100 patients offered active surveillance
      • 99 out of 100 patients offered radical prostatectomy
      • 99 out of 100 patients offered radical radiotherapy

  • What effect does each treatment option have on disease progression?
    • good evidence that both prostatectomy and radiotherapy reduce disease progression compared with active surveillance. Signs of disease progression were reported in:
      • 21 out of 100 patients offered active surveillance
      • 8 out of 100 patients offered radical prostatectomy
      • 8 out of 100 patients offered radical radiotherapy

  • What effect does each treatment option have on the rate of development of distant metastases?
    • good evidence that both prostatectomy and radiotherapy reduce the rate of development of distant metastases compared with active surveillance. Distant metastases were developed in:
      • 8 out of 100 patients offered active surveillance
      • 3 out of 100 patients offered radical prostatectomy
      • 3 out of 100 patients offered radical radiotherapy

  • What effect does each treatment option have on urinary function?
    • some evidence that urinary function is better for people offered active surveillance or radiotherapy than those offered prostatectomy.
    • Problems with urinary continence:
      • At 6 months, problems were reported in:
        • 39 out of 100 patients offered active surveillance
        • 71 out of 100 patients offered radical prostatectomy
        • 38 out of 100 patients offered radical radiotherapy.
      • At 6 years, problems were reported in:
        • 50 out of 100 patients offered active surveillance
        • 69 out of 100 patients offered radical prostatectomy
        • 49 out of 100 patients offered radical radiotherapy

    • Moderate to severe urinary incontinence problems:
      • At 6 months, problems were reported in:
        • 4 out of 100 patients offered active surveillance
        • 19 out of 100 patients offered radical prostatectomy
        • 6 out of 100 patients offered radical radiotherapy.
      • At 6 years, problems were reported in:
        • 8 out of 100 patients offered active surveillance
        • 13 out of 100 patients offered radical prostatectomy
        • 5 out of 100 patients offered radical radiotherapy

  • What effect does each treatment option have on erectile dysfunction?
    • Erectile dysfunction, moderate or severe problems:
      • At 6 months, problems were reported in:
        • 29 out of 100 patients offered active surveillance
        • 66 out of 100 patients offered radical prostatectomy
        • 48 out of 100 patients offered radical radiotherapy
      • At 6 years, problems were reported in:
        • 40 out of 100 patients offered active surveillance
        • 50 out of 100 patients offered radical prostatectomy
        • 36 out of 100 patients offered radical radiotherapy

  • What effect does each treatment option have on bowel function?
    • Problems with faecal incontinence more than once per week:
      • At 6 months, problems were reported in:
        • 2 out of 100 patients offered active surveillance
        • 1 out of 100 patients offered radical prostatectomy
        • 5 out of 100 patients offered radical radiotherapy.
      • At 6 years, problems were reported in:
        • 3 out of 100 patients offered active surveillance
        • 2 out of 100 patients offered radical prostatectomy
        • 4 out of 100 patients offered radical radiotherapy

Disease progression was suspected if there was:

  • any rise in prostate-specific antigen (PSA) >20% between consecutive measures at any time during follow-up or
  • any rise in PSA level of 50% or greater in any 12-month period confirmed by repeat tests or
  • any indication of the appearance of symptomatic systemic disease.

Reference:


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