5 October 2016
The CLAHRC West optimal care research programme focuses on investigating how to reduce procedures or treatments that do not have clear evidence of benefit or may cause unnecessary harm.
The NIHR ProtecT study, co-led by Professor Jenny Donovan, Director of CLAHRC West, has been investigating the effectiveness and acceptability of radical surgery, radical radiotherapy or active monitoring treatments for clinically localised prostate cancer since 1998.
The first major results have just been published in two linked papers in the New England Journal of Medicine:
These show that active monitoring is as effective as surgery and radiotherapy in terms of survival at a median of 10 years – with a 99 per cent survival rate from prostate cancer following all three treatments.
Surgery and radiotherapy reduced the risk of cancer spread or progression compared with active monitoring, but caused a number of unpleasant and bothersome side-effects. These included problems with sexual function following surgery and radiotherapy, urine leakage following surgery, and some bowel problems following radiotherapy.
Longer follow-up is needed to determine the ‘best’ management strategy, but now men diagnosed with localised prostate cancer can use the findings to make a considered decision about which treatment to have. They do not need to rush to choose a treatment, but can weigh up the different aspects in relation to their lifestyles and preferences.
Co-lead investigator Professor Freddie Hamdy, from the University of Oxford, said:
“What we have learnt from this study so far is that prostate cancer detected by PSA blood test grows very slowly, and very few men die of it when followed up over a period of 10 years – around one per cent – irrespective of the treatment assigned. This is considerably lower than anticipated when we started the study. However, treating the disease radically when found reduces the number of men who develop spread of prostate cancer, but we do not know yet whether this will make a difference to them living longer or better, and we have been unable to determine reliably which disease is lethal, and which can be left alone.”
Professor Jenny Donovan, co-lead investigator from the University of Bristol and Director of NIHR CLAHRC West said:
“This is the first time radiotherapy, surgery and active monitoring treatments for prostate cancer have been compared directly. Each treatment has different impacts and effects, and these results provide patients and clinicians with detailed information so that they can make an informed decision about which treatment to have.”
Visit the ProtecT web pages for the full papers, interviews and other information.
In terms of the relevance for CLAHRC West, Director Jenny Donovan said:
“CLAHRC West has an important role to play in working out how to implement the findings from the NIHR ProtecT study in clinical and commissioning practice, locally and nationally, and to help men make informed choices. Although we need longer follow up to be definitive, we can provide materials and support for clinicians based on this robust evidence. This will enable men with localised prostate cancer to take their time and choose a treatment that fits their wishes in relation to their lifestyle and health status. We have set up a small group to work on this and particularly welcome input from colleagues interested in helping us locally.”
If you wish to be involved, please contact clahrcwest@nihr.ac.uk.