Informed decision.

Top Line: Individualized decisions on the best treatment for localized prostate cancer usually boils down to expected toxicity.

The Study: Ok, in reality it probably doesn’t, but it should. In standard UK fashion, the large ProtecT was designed to prospectively capture most men with prostate cancer and delivers data after data. Here is a detailed report of toxicity and quality of life for 2565 men with localized prostate cancer diagnosed 1999-2019. Of these 1135 (44%) received active surveillance, 750 (29%) radical prostatectomy, 603 (24%) external-beam radiation with concurrent androgen-deprivation therapy (ADT) and 77 (3%) low-dose-rate brachytherapy. It’s important to first recognize the steady decline in sexual and urinary function with time among the men undergoing active surveillance: from baseline to year 6, incidence of erectile dysfunction increased from 35% → 53% and nocturia 20% → 38%. As expected, almost all men experienced erectile dysfunction immediately after prostatectomy (95%) with minimal recovery at 6 years (85%) and, while less severe, still the majority experienced erectile dysfunction immediately after external beam radiation + ADT (69%) and at 6 years (74%). Also to no real surprise, urinary leakage requiring at least 1 pad per day was a unique problem after prostatectomy occurring in 36% immediately after and 20% at 6 years, while worse bowel function and bother was unique among men following external radiation with some degree of fecal incontinence reported by 10% at 6 years and bloody bowel movements in 6%.

TBL: The ProtecT trial continues to provide long-term outcome data to counsel men with prostate cancer who are deciding among treatment options. | Lane, BJU Int 2022