Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer

被引：6

作者：

Hamdy, F. C. C. ^{[1
,2
]}

Donovan, J. L. L. ^{[3
]}

Lane, J. A. ^{[3
,4
]}

Metcalfe, C. ^{[3
,4
]}

Davis, M. ^{[3
]}

Turner, E. L. L. ^{[3
]}

Martin, R. M. M. ^{[3
]}

Young, G. J. J. ^{[3
,4
]}

Walsh, E. I. I. ^{[3
]}

Bryant, R. J. J. ^{[2
]}

Bollina, P. ^{[8
]}

Doble, A. ^{[9
]}

Doherty, A. ^{[12
]}

Gillatt, D. ^{[21
]}

Gnanapragasam, V ^{[10
,11
]}

Hughes, O. ^{[13
]}

Kockelbergh, R. ^{[16
]}

Kynaston, H. ^{[13
]}

Paul, A. ^{[17
]}

Paez, E. ^{[18
]}

Powell, P. ^{[18
]}

Rosario, D. J. J. ^{[19
]}

Rowe, E. ^{[5
,6
]}

Mason, M. ^{[14
]}

Catto, J. W. F. ^{[19
,20
]}

Peters, T. J. J. ^{[3
]}

Oxley, J. ^{[7
]}

Williams, N. J. J. ^{[3
]}

Staffurth, J. ^{[15
]}

Neal, D. E. E. ^{[2
,10
,11
]}

机构：

[1] Univ Oxford, Nuffield Dept Surg Scienc es, Old Rd Campus Res Bldg, Roosevelt Dr, Headington, Oxford OX3 7DQ, England

[2] Univ Oxford, Nuffield Dept Surg Sci, Oxford, England

[3] Univ Bristol, Populat Hlth Sci, Bristol, England

[4] Univ Bristol, Bristol Trials Ctr, Bristol, England

[5] Univ Bristol, Southmead Hosp, Bristol Med Sch, Dept Urol, Bristol, England

[6] Bristol Urol Inst, Bristol, England

[7] North Bristol NHS Trust, Dept Cellular Pathol, Bristol, England

[8] Univ Edinburgh, Western Gen Hosp, Dept Urol & Surg, Edinburgh, Scotland

[9] Addenbrookes Hosp, Dept Urol, Cambridge, England

[10] Addenbrookes Hosp, Dept Urol, Div Urol, Cambridge, England

[11] Addenbrookes Hosp, Cambridge Urol Translat Res & Clin Trials Off, Cambridge Biomed Campus, Cambridge, England

[12] Queen Elizabeth Hosp, Dept Urol, Birmingham, England

[13] Cardiff & Vale Univ Hlth Board, Dept Urol, Cardiff, Wales

[14] Cardiff Univ, Sch Med, Cardiff, Wales

[15] Cardiff Univ, Div Canc & Genet, Cardiff, Wales

[16] Univ Hosp Leicester, Dept Urol, Leicester, England

[17] Leeds Teaching Hosp NHS Trust, Dept Urol, Leed, England

[18] Freeman Rd Hosp, Dept Urol, Newcastle Upon Tyne, England

[19] Royal Hallamshire Hosp, Dept Urol, Sheffield, England

[20] Univ Sheffield, Med Sch, Acad Urol Unit, Sheffield, England

[21] Macquarie Univ, Dept Urol Oncol & Robot Surg, Sydney, Australia

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2023年 / 388卷 / 17期

关键词：

RADICAL PROSTATECTOMY; TRIAL; INTERVENTION; DESIGN;

D O I：

暂无

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age received a prostate-specific antigen (PSA) test. Localized prostate cancer was diagnosed in 2664 men. Of these men, 1643 were enrolled in a trial to evaluate the effectiveness of treatments, with 545 randomly assigned to receive active monitoring, 553 to undergo prostatectomy, and 545 to undergo radiotherapy.Methods At a median follow-up of 15 years (range, 11 to 21), we compared the results in this population with respect to death from prostate cancer (the primary outcome) and death from any cause, metastases, disease progression, and initiation of long-term androgen-deprivation therapy (secondary outcomes).Results Follow-up was complete for 1610 patients (98%). A risk-stratification analysis showed that more than one third of the men had intermediate or high-risk disease at diagnosis. Death from prostate cancer occurred in 45 men (2.7%): 17 (3.1%) in the active-monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group (P=0.53 for the overall comparison). Death from any cause occurred in 356 men (21.7%), with similar numbers in all three groups. Metastases developed in 51 men (9.4%) in the active-monitoring group, in 26 (4.7%) in the prostatectomy group, and in 27 (5.0%) in the radiotherapy group. Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively; clinical progression occurred in 141 men (25.9%), 58 (10.5%), and 60 (11.0%), respectively. In the active-monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. No differential effects on cancer-specific mortality were noted in relation to the baseline PSA level, tumor stage or grade, or risk-stratification score. No treatment complications were reported after the 10-year analysis.Conclusions After 15 years of follow-up, prostate cancer-specific mortality was low regardless of the treatment assigned. Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer. (Funded by the National Institute for Health and Care Research; ProtecT Current Controlled Trials number, ; ClinicalTrials.gov number, .)

引用

页码：1547 / 1558

页数：12

共 50 条

[1] Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer
Hamdy, F. C. C.
Donovan, J. L. L.
Lane, J. A.
Metcalfe, C.
Davis, M.
Turner, E. L. L.
Martin, R. M. M.
Young, G. J. J.
Walsh, E. I. I.
Bryant, R. J. J.
Bollina, P.
Doble, A.
Doherty, A.
Gillatt, D.
Gnanapragasam, V
Hughes, O.
Kockelbergh, R.
Kynaston, H.
Paul, A.
Paez, E.
Powell, P.
Rosario, D. J. J.
Rowe, E.
Mason, M.
Catto, J. W. F.
Peters, T. J. J.
Oxley, J.
Williams, N. J. J.
Staffurth, J.
Neal, D. E. E.
ProtecT Study Grp
[J]. BJU INTERNATIONAL, 2023, 131 (06) : 641 - 641
[2] Re: Fifteen-Year Outcomes After Monitoring, Surgery, or Radiotherapy for Prostate Cancer
Chang, Davi
Appu, Sree
Siva, Shankar
[J]. EUROPEAN UROLOGY, 2023, 84 (04) : 436 - 437
[3] Re: Fifteen-year Outcomes After Monitoring, Surgery, or Radiotherapy for Prostate Cancer
Sharma, Abhishek D.
Lopez, Jose F.
Leiblich, Aaron
Leslie, Tom A.
Lamb, Alastair D.
[J]. EUROPEAN UROLOGY, 2020, 84 (02) : 245 - 246
[4] Fifteen-year outcomes after monitoring, surgery or radiation therapy for prostate cancer
Spohn, Simon K. B.
Grosu, Anca-Ligia
[J]. STRAHLENTHERAPIE UND ONKOLOGIE, 2024, : 250 - 252
[5] Fifteen-year survival and recurrence rates after radiotherapy for localized prostate cancer
Eastham, JA
Kattan, MW
Groshen, S
Scardino, PT
Rogers, E
Carlton, CE
Lerner, SP
[J]. JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (10) : 3214 - 3222
[6] Fifteen-Year Outcomes of the ProtecT Trial for Localized Prostate Cancer
Davis, Matthew J.
Stephens, Alex
Abdollah, Firas
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2023, 389 (01): : 90 - 92
[7] Fifteen-year survival with prostate cancer in Sweden
Aus, G
Hugosson, J
[J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 278 (03): : 205 - 206
[8] 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer
Hamdy, F. C.
Donovan, J. L.
Lane, J. A.
Mason, M.
Metcalfe, C.
Holding, P.
Davis, M.
Peters, T. J.
Turner, E. L.
Martin, R. M.
Oxley, J.
Robinson, M.
Staffurth, J.
Walsh, E.
Bollina, P.
Catto, J.
Doble, A.
Doherty, A.
Gillatt, D.
Kockelbergh, R.
Kynaston, H.
Paul, A.
Powell, P.
Prescott, S.
Rosario, D. J.
Rowe, E.
Neal, D. E.
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2016, 375 (15): : 1415 - 1424
[9] Fifteen-Year Outcomes of the ProtecT Trial for Localized Prostate Cancer-Reply
Hamdy, Freddie C.
Donovan, Jenny L.
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2023, 389 (01): : 92 - 92
[10] Fifteen-year survival with prostate cancer in Sweden - Reply
Johansson, JE
Holmberg, L
Bergstrom, R
Adami, HO
Johansson, S
[J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 278 (03): : 206 - 206

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