comparison of active surveillance , radical prostatectomy or radical radiotherapy to people with low - risk localised prostate cancer

Last edited 06/2019 and last reviewed 05/2023

Low-risk localised prostate cancer

• choice between active surveillance, radical prostatectomy or radical radiotherapy to people with low-risk localised prostate cancer for whom radical treatment is suitable

Factors to consider when discussing active surveillance, radical prostatectomy or radical radiotherapy as treatment options for people with low-risk or intermediate-risk localised prostate cancer, using evidence from a large UK trial

• What effect does each treatment option have on survival?
  • evidence does not show a difference in the number of deaths from prostate cancer among people offered active surveillance, prostatectomy or radical radiotherapy. People who had not died of prostate cancer were:
    • 98 out of 100 patients offered active surveillance
    • 99 out of 100 patients offered radical prostatectomy
    • 99 out of 100 patients offered radical radiotherapy
      
      
• What effect does each treatment option have on disease progression?
  • good evidence that both prostatectomy and radiotherapy reduce disease progression compared with active surveillance. Signs of disease progression were reported in:
    • 21 out of 100 patients offered active surveillance
    • 8 out of 100 patients offered radical prostatectomy
    • 8 out of 100 patients offered radical radiotherapy
      
      
• What effect does each treatment option have on the rate of development of distant metastases?
  • good evidence that both prostatectomy and radiotherapy reduce the rate of development of distant metastases compared with active surveillance. Distant metastases were developed in:
    • 8 out of 100 patients offered active surveillance
    • 3 out of 100 patients offered radical prostatectomy
    • 3 out of 100 patients offered radical radiotherapy
      
      
• What effect does each treatment option have on urinary function?
  • some evidence that urinary function is better for people offered active surveillance or radiotherapy than those offered prostatectomy.
  • Problems with urinary continence:
    • At 6 months, problems were reported in:
      • 39 out of 100 patients offered active surveillance
      • 71 out of 100 patients offered radical prostatectomy
      • 38 out of 100 patients offered radical radiotherapy.
    • At 6 years, problems were reported in:
      • 50 out of 100 patients offered active surveillance
      • 69 out of 100 patients offered radical prostatectomy
      • 49 out of 100 patients offered radical radiotherapy
        
        
  • Moderate to severe urinary incontinence problems:
    • At 6 months, problems were reported in:
      • 4 out of 100 patients offered active surveillance
      • 19 out of 100 patients offered radical prostatectomy
      • 6 out of 100 patients offered radical radiotherapy.
    • At 6 years, problems were reported in:
      • 8 out of 100 patients offered active surveillance
      • 13 out of 100 patients offered radical prostatectomy
      • 5 out of 100 patients offered radical radiotherapy
        
        
• What effect does each treatment option have on erectile dysfunction?
  • Erectile dysfunction, moderate or severe problems:
    • At 6 months, problems were reported in:
      • 29 out of 100 patients offered active surveillance
      • 66 out of 100 patients offered radical prostatectomy
      • 48 out of 100 patients offered radical radiotherapy
    • At 6 years, problems were reported in:
      • 40 out of 100 patients offered active surveillance
      • 50 out of 100 patients offered radical prostatectomy
      • 36 out of 100 patients offered radical radiotherapy
        
        
• What effect does each treatment option have on bowel function?
  • Problems with faecal incontinence more than once per week:
    • At 6 months, problems were reported in:
      • 2 out of 100 patients offered active surveillance
      • 1 out of 100 patients offered radical prostatectomy
      • 5 out of 100 patients offered radical radiotherapy.
    • At 6 years, problems were reported in:
      • 3 out of 100 patients offered active surveillance
      • 2 out of 100 patients offered radical prostatectomy
      • 4 out of 100 patients offered radical radiotherapy

Disease progression was suspected if there was:

• any rise in prostate-specific antigen (PSA) >20% between consecutive measures at any time during follow-up or
• any rise in PSA level of 50% or greater in any 12-month period confirmed by repeat tests or
• any indication of the appearance of symptomatic systemic disease.

Reference:

• NICE (May 2019). Prostate cancer: diagnosis and management