September 14, 2016

expert reaction to two studies reporting results on monitoring prostate cancer versus surgery or radiotherapy, and survival and cancer progression

Two studies published in the New England Journal of Medicine reported that in men with localised prostate cancer (that hadn’t spread) active monitoring was not significantly more dangerous than surgery or radiotherapy in terms of survival, and that surgery and radiotherapy reduce the risk of cancer progression compared with active monitoring but can also cause more unpleasant side-effects including sexual or bowel impairment.

Prof. Jack Cuzick, John Snow Professor of Epidemiology, Director of the Wolfson Institute of Preventive Medicine, and Head of the Centre for Cancer Prevention, QMUL, said:

“This trial provides important data on the use of active surveillance in early prostate cancer. However it is too soon still to be confident that it is as effective as surgery or radiotherapy in preventing death from the disease. Rates of metastatic spread were clearly higher in the surveillance group, and the non-significant increase in the number of deaths from prostate cancer suggests they may also be increased. However it is too early to be certain about this as the number of such deaths is still very small. Further follow up will be essential to clarify this finding.

“New tests are being developed which should better identify from a small diagnostic needle biopsy which men with early prostate cancer are at risk of developing metastases and dying from this disease, and thus need more invasive treatment immediately, and which can be safely watched.”

Prof. Sir John Burn, Professor of Clinical Genetics, Newcastle University, said:

“This is valuable information for men faced with difficult choices. This research focuses on men with localised prostate cancer (that hasn’t spread) – 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.

“This is a high quality piece of research in a difficult area. Demonstrating that it is safe to do nothing is never easy.”

‘10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer’ by F. C. Hamdy et al. published in the New England Journal of Medicine on Wednesday 14 September 2016.

‘Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer’ by J. L. Donovan et al. published in the New England Journal of Medicine on Wednesday 14 September 2016. 

Declared interests

Prof. Jack Cuzick: “I receive a percentage of royalties provided to my institution from Myriad Genetics for development of a cell cycle progression score (Prolaris) designed to better separate indolent form aggressive prostate cancer.”

Prof. Sir John Burn: “I chair a company developing DNA testing devices (QuantuMDx ltd).  I am a non-executive director of NHS England.  The above opinion is my own.”