A decade-long investigation discovered that 99 per cent of men found to have a localized form of the disease who chose active monitoring were still alive ten years later – exactly mirroring the rate of those who chose radiotherapy or surgery.
Of the patients who chose surveillance rather than treatment, 80 per cent experienced no spread of their cancer during the period of the trial.
Experts say the findings should
give men greater confidence to avoid the traditional options, which
leave many with urinary problems and impaired sexual function.
Around 47,000 men are diagnosed with prostate cancer each year in the UK, about half of whom are caught at an early stage before the disease has spread.
There is currently no screening for the disease, although men are entitled to a test if they ask for one.
Professor Freddie Hamdy, from the University of Oxford, who led the research, said: “What we have learn from this study so far is that prostate cancer detected by PSA (prostate-specific antigen) blood test grows very slowly, and very few men die of it when followed up over a period of 10 years – around 1 per cent, irrespective of the treatment assigned.
“This is considerably lower than anticipated when we started the study.”
Around 47,000 men are diagnosed with prostate cancer each year in the UK, about half of whom are caught at an early stage before the disease has spread.
There is currently no screening for the disease, although men are entitled to a test if they ask for one.
Professor Freddie Hamdy, from the University of Oxford, who led the research, said: “What we have learn from this study so far is that prostate cancer detected by PSA (prostate-specific antigen) blood test grows very slowly, and very few men die of it when followed up over a period of 10 years – around 1 per cent, irrespective of the treatment assigned.
“This is considerably lower than anticipated when we started the study.”
Between 1999 and 2009, 1,643 men
aged 50 to 69 were given one of the three treatments, from a sample of
82,429 men with localized prostate cancer.
The results, published in the New England Journal of Medicine, revealed that surgery or radiotherapy reduced cancer spreading by more than half compared with active monitoring, occurring in less than 10 per cent of men rather than around 20 per cent for the monitored group.
But the overall 10-year survival rate was the same between groups.
Active monitoring, which aims to keep patients within a “window of curability”, involves testing every three months after a cancer diagnosis.
If the condition has not worsened after two years the test become twice yearly and then annually.
Statistics from Prostate Cancer UK suggests that around 15 per cent of patients currently take this option.
Sir John Burn, professor of clinical genetics at Newcastle University, said: “This is valuable information for men faced with difficult choices.
“Many will conclude that doing nothing is preferable to surgery or radiotherapy.
“The bottom line seems to be that for these men with localised prostate cancer, active monitoring is not significantly more dangerous and avoids the potential burden of medically induced sexual or bowel impairment.
“Obviously if there is evidence of spread the situation is different.”
Sir John praised the quality of the research, adding: “Demonstrating that is safe to do nothing is never easy.”
However, the research team stressed that their conclusions only apply to ten-year survival rates and they cannot be sure that active monitoring, rather than radiotherapy or surgery, provides equally good outcomes over a longer period.
Professor Hamdy said that longer follow-up study was now required to determine the trade-off between cancer outcomes and quality of life, as well as further research into understanding different forms of the disease.
Dr Matthew Hobbs, from Prostate Cancer UK, described the results from the study, which was funded by the NHS, “hugely positive”.
“At the moment, many men decide against active surveillance because of the uncertainty about the impact of that choice and the anxiety it causes,” he said.
“It is extremely reassuring to hear that, when it performed to a high standard, active surveillance gives men the same chance of survival at 10 years as men who chose surgery or radiotherapy.”
The results, published in the New England Journal of Medicine, revealed that surgery or radiotherapy reduced cancer spreading by more than half compared with active monitoring, occurring in less than 10 per cent of men rather than around 20 per cent for the monitored group.
But the overall 10-year survival rate was the same between groups.
Active monitoring, which aims to keep patients within a “window of curability”, involves testing every three months after a cancer diagnosis.
If the condition has not worsened after two years the test become twice yearly and then annually.
Statistics from Prostate Cancer UK suggests that around 15 per cent of patients currently take this option.
Sir John Burn, professor of clinical genetics at Newcastle University, said: “This is valuable information for men faced with difficult choices.
“Many will conclude that doing nothing is preferable to surgery or radiotherapy.
“The bottom line seems to be that for these men with localised prostate cancer, active monitoring is not significantly more dangerous and avoids the potential burden of medically induced sexual or bowel impairment.
“Obviously if there is evidence of spread the situation is different.”
Sir John praised the quality of the research, adding: “Demonstrating that is safe to do nothing is never easy.”
However, the research team stressed that their conclusions only apply to ten-year survival rates and they cannot be sure that active monitoring, rather than radiotherapy or surgery, provides equally good outcomes over a longer period.
Professor Hamdy said that longer follow-up study was now required to determine the trade-off between cancer outcomes and quality of life, as well as further research into understanding different forms of the disease.
Dr Matthew Hobbs, from Prostate Cancer UK, described the results from the study, which was funded by the NHS, “hugely positive”.
“At the moment, many men decide against active surveillance because of the uncertainty about the impact of that choice and the anxiety it causes,” he said.
“It is extremely reassuring to hear that, when it performed to a high standard, active surveillance gives men the same chance of survival at 10 years as men who chose surgery or radiotherapy.”
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