Episode 16: Active surveillance solidified as standard of care for patients with low-risk, localized prostate cancer: 15-year update from ProtecT

In this new episode of WND Prostate cancer, Prof Bertrand Tombal from the Cliniques Universitaires Saint-Luc in Brussels, and Prof Steven Joniau from the University Hospitals Leuven share their insights on the ProtecT trial, probably the most important study in patients with localized prostate cancer from the last decade.

In ProtecT, a total of 1,643 patients with localized prostate cancer were randomly assigned to active surveillance (N= 545), prostatectomy (N= 553), or radiotherapy (N= 545). At baseline, 77.2% of the men were in Gleason grade group 1 (Gleason score, 3+3=6) and 76.0% had a stage T1c cancer. While the ProtecT population is generally considered to be a low-risk population, it must be noted that, according to contemporary risk-stratification tools (D’Amico criteria), 24.1% of patients in this study had intermediate-risk disease and 9.6% even had high-risk disease.¹

After 15 years of follow-up, no significant difference in prostate cancer specific survival was seen across the three trial groups, with a 15-year prostate cancer mortality rate of 2.2%, 2.9% and 3.1% for patients in the active surveillance, prostatectomy, and radiotherapy group, respectively.¹

Despite these data, however, a proportion of physicians continues to opt for more aggressive treatment strategies in these patients. A common argument that is used by these physicians is that ProtecT also showed a higher risk for future ADT need in patients in the active surveillance arm which, according to them, would ultimately have a detrimental impact on their quality of life (QoL). In reality, however, the QoL of patients in ProtecT was highest in the active surveillance arm.

For Prof Joniau and Prof Tombal, this 15-year update of ProtecT further solidifies active surveillance as the way to go in patients with localized, (intermediate)-low risk prostate cancer, an opinion that is shared by the most recent EAU treatment guidelines for prostate cancer.²