Active surveillance reduces the need for surgery, with no change in mortality, at the price of a small increase of metastatic disease (ProtecT)

Clinical Question

What are the benefits and harms of different approaches to the treatment of screen-detected prostate cancer?

Bottom line

Active surveillance provides a balance of benefits and harms. After 15 years, for every 100 participants 40 can avoid the need for surgery with no increase in the risk of death, although 3 to 4 more develop metastatic disease than in the groups treated initially with surgery or radiation.(LOE = 1b)

Overuse alert: This POEM aligns with Choosing Wisely Canada's patient material on low-risk prostate cancer.

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (specialty)

Reviewer

Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA


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Comments

ARUP KUMAR DHARA

Impact assessment

Excellent

Anonymous

Impact assessment protecT

learned new

Anonymous

Active surveillance in prostate cancer

Confirms what I think most FP’s are already foing

Anonymous

Typical of Government funded studies

Saving money at the expense of 3-4 % of population - this is not medicine it is rationing of healthcare - at least there should be another study of the result of this study and informed consent - I fear for the future when the only outcome is saving finances and not focused on health - is 4% lose now the acceptable standard

Anonymous

Active surveillance vs surgery for prostate cancer.

I think those who develop metastatic disease might wish they had surgery when it was an option. These are the patients I treat as a GPO.

Anonymous

prostate ca surveillance

after 15 years , 3-4 pts will die from metastatic disease, left untreated

John Charles Wootton

Active surveillance

The few patients who develop metastatic disease may nevertheless be dissatisfied with the outcome, and with your care.