SOURCE: Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375:1415-1424.

For the past three decades, the majority of prostate cancer (PRCA) detection has resulted from prostate-specific antigen (PSA) screening. As compared to pre-PSA modes of detection, the population of PSA screening-detected PRCA is prominently comprised of earlier, prostate-localized disease. Is there a clear advantage to one path of long-term intervention than another in long-term management of localized PRCA?

From a population of 84,429 PSA-screened men in the United Kingdom, 2,664 were diagnosed with localized PRCA and randomized to active surveillance vs. radical prostatectomy vs. external beam radiation. Although prostatectomy and external beam radiation probably are self-explanatory, the method of “active surveillance” differs from the “watching waiting” in two other prostate cancer trials. That is, active surveillance entailed PSA measurement every three months for a year, and then every six to 12 months going forward. Any 12-month PSA increase of 50% or greater prompted a case review and reconsideration of intervention; ultimately, 56 men in the active surveillance group ended up receiving an intervention secondary to increases in PSA.

At 10 years of follow-up, there was no statistically significant difference in either PRCA-specific death or all-cause mortality between the three groups. Although these results are heartening in that the three methods demonstrated similar (and low) levels of mortality, the relatively younger age of these men (mean age = 62 years) and the fact that disease progression over 10 years was more common in the surveillance group indicates that even longer-term follow-up will be needed to fully inform men on how to make optimum choices.