📃 Paper Title: 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localised Prostate Cancer
🧍 Author: Hamdy
🕒 Year: 2016
📚 Journal: NEJM
🌎 Country: UK
ㅤContext to the study:
Which study found no significant difference in the rates of death between prostate cancer patients assigned to active monitoring, surgery or radiotherapy?
ㅤ✅ Take-home message of study:
This study compared the effectiveness of active monitoring, surgery or radiotherapy in patients diagnosed with localised prostate cancer. At 10-years, they found that there was no significant difference in the rates of death between the groups, but found that there was a greater rate of metastases and disease progression in the active monitoring group, when compared to surgery or radiotherapy.
ㅤ Prospective, multi-centre randomised controlled trial
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Study participants:
Between 1999-2009 82,429 men 50-69 years old had a PSA test 2,664 diagnosed with localised PCa 1,643 agreed to be randomised 545 active monitoring, 553 surgery, 545 radiotherapy.
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Key study outcomes:
Primary outcome:
Prostate-cancer mortality at a median of 10 years follow-up.
Secondary outcome(s):
Rates of disease progression
Rates of metastases
Rates of all-cause deaths
Primary treatment failure
Treatment complications
Non-significant difference in PCa specific deaths between groups.
Non-significant difference in number of deaths from any cause between groups.
Statistically significant increase in rates of metastases and disease progression in active monitoring group when compared to surgery or radiotherapy.
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Study Limitations:
Protocol developed almost 20 years prior.
mpMRI not used to evaluate patients at diagnosis or for monitoring.
Brachytherapy not included in radiotherapy arm.
< 1% of participants enrolled were of African-Caribbean ancestry (but this reflected the population of the recruiting centres).
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mpMRI not used to evaluate patients at diagnosis or for monitoring.
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