Abstract: PD03-01
Sources of Funding: none

Introduction

The recently published outcomes of the ProtecT trial showed no difference in PCa-specific survival after a median of 10 yr follow-up between surgery (RP), radiotherapy (RT) and active monitoring (AM) in men with screen detected localized prostate cancer (PCa) [1]. However, data also showed a higher rate of metastatic (M+) PCa in the AM arm. Caveat of ProtecT are the randomization of PCa cases into the AM arm that are considered high risk and the AM protocol which is substantially different from current Active Surveillance (AS) protocols.

Methods

From men diagnosed with PCa at the 1st and 2nd screening round of ERSPC Rotterdam (1993-2003) considered suitable for AS (i.e Gleason score ≤3+3, ≤T2a PCa cases), we calculated PCa-specific survival and rate of M+ PCa and compared these outcomes between men treated with AS predominantly according to the PRIAS protocol (n=223), having had a RP (N=365) or treated with RT (n=312)._x000D_

Results

Baseline characteristics are listed in Table 1 and reflect the non-randomized setting. However, statistically significant differences do not automatically translate to clinically relevant differences. After a median follow-up of 15-yr (IQR 12-17 yr), 18 men died from PCa. Similar to ProtecT, no significant difference in PC specific survival was found between AS (97.2%; 95% CI: 94.7-99.7), RP (98.5%; 95% CI: 97.2-99.8), and RT (97.5%; 95% CI: 95.5-99.5), log-rank p=0.36. However, contrary to ProtecT, M+-free survival was also similar with rates of 96.9% (95% CI: 94.4-99.4) for AS, 97.9% (95% CI: 96.3-99.5) for RP and 96.6% (95% CI: 94.4-99.0) for RT, log-rank p=0.42 (Table 2).

Conclusions

The current data support a comparable long-term risk of disease progression of low-risk PCa in men initially treated with AS according to a protocol including regular monitoring with PSA, DRE and prostate biopsy and men opting for immediate active treatment. Personal preferences including considerations on quality of life will become more and more important in the treatment decision of low-risk PCa._x000D_ _x000D_ 1. Hamdy et al. NEJM. PMID: 27626136

Funding

none