Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT
Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials co...
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| Published in | Health technology assessment (Winchester, England) Vol. 24; no. 37; pp. 1 - 176 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
NIHR Journals Library
01.08.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1366-5278 2046-4924 2046-4924 |
| DOI | 10.3310/hta24370 |
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| Abstract | Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments.
To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years.
A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up.
Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK.
Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (
= 545), radical prostatectomy (
= 553) or radical radiotherapy (
= 545) and 997 chose a treatment.
The interventions were active monitoring, radical prostatectomy and radical radiotherapy.
Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants.
Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes.
There were no statistically significant differences between the groups for 17 prostate cancer-specific (
= 0.48) and 169 all-cause (
= 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring,
= 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy,
= 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy,
= 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years;
= 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (
= 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (
= 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (
= 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years;
< 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy).
A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed.
At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years.
Current Controlled Trials ISRCTN20141297.
This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in
; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information. |
|---|---|
| AbstractList | Background: Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. Objectives: To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50–69 years. Design: A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Setting: Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Participants: Between 2001 and 2009, 228,966 men aged 50–69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. Interventions: The interventions were active monitoring, radical prostatectomy and radical radiotherapy. Trial primary outcome measure: Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. Secondary outcome measures: Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. Results: There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy’s impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy). Limitations: A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. Conclusions: At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. Trial registration: Current Controlled Trials ISRCTN20141297. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information. Prostate cancer is the most common cancer in men and is often found through a blood test called a prostate-specific antigen test and through biopsies of the prostate. Over the years, these tests led to the detection of many small cancers that do not cause harm. Some prostate cancers are harmful, but it is difficult to recognise them early. When cancer is still inside the prostate, the conventional treatments are surgery or radiotherapy, which carry side effects including leaking urine and difficulty getting an erection, so another option is repeat investigations at regular intervals (active monitoring), with treatments given if the cancer progresses. These options needed to be compared in a study called a ‘randomised trial’ in which men agree to be allocated to one of the three treatments. In the Prostate testing for cancer and Treatment (ProtecT) study, 200,000 men aged 50–69 years were invited to have a prostate-specific antigen test. Of the 82,849 men who agreed to be tested, 1643 of whom had prostate cancer that was still contained in the prostate agreed to be allocated to one of the three treatments. After an average of 10 years of follow-up, 99% of men were alive in each of the treatment groups. However, when compared with active monitoring, surgery and radiotherapy reduced the risk of disease spreading outside the prostate by half. Patients reported that urinary leakage and sexual function were worst with surgery, and sexual and bowel functions were affected by radiotherapy. Men on active monitoring had a gradual decline in their urinary and sexual function, particularly as around half of them later had surgery or radiotherapy. Radiotherapy was the treatment that seemed to be the best value for money. The findings from the Prostate testing for cancer and Treatment (ProtecT) study can help men make decisions about being tested and which treatment to have if they are found to have cancer within the prostate. We now need to find out the longer-term effects of these treatments on how long men live and their quality of life. Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years. A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring ( = 545), radical prostatectomy ( = 553) or radical radiotherapy ( = 545) and 997 chose a treatment. The interventions were active monitoring, radical prostatectomy and radical radiotherapy. Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. There were no statistically significant differences between the groups for 17 prostate cancer-specific ( = 0.48) and 169 all-cause ( = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring ( = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy ( = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy ( = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy). A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. Current Controlled Trials ISRCTN20141297. This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in ; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information. Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments.BACKGROUNDProstate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments.To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years.OBJECTIVESTo evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years.A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up.DESIGNA prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up.Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK.SETTINGProstate-specific antigen testing in primary care and treatment in nine urology departments in the UK.Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment.PARTICIPANTSBetween 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment.The interventions were active monitoring, radical prostatectomy and radical radiotherapy.INTERVENTIONSThe interventions were active monitoring, radical prostatectomy and radical radiotherapy.Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants.TRIAL PRIMARY OUTCOME MEASUREDefinite or probable disease-specific mortality at the 10-year median follow-up in randomised participants.Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes.SECONDARY OUTCOME MEASURESOverall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes.There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy).RESULTSThere were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy).A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed.LIMITATIONSA single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed.At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years.CONCLUSIONSAt a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years.Current Controlled Trials ISRCTN20141297.TRIAL REGISTRATIONCurrent Controlled Trials ISRCTN20141297.This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information.FUNDINGThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technol |
| Author | Gillatt, David Peters, Tim J Lane, J Athene Bollina, Prasad Metcalfe, Chris Gnanapragasam, Vincent Oxley, Jon Blazeby, Jane Martin, Richard M Catto, James Young, Grace Rosario, Derek Davis, Michael Kynaston, Howard Kockelbergh, Roger Garfield, Kirsty Holding, Peter Walsh, Eleanor Turner, Emma L Doble, Andrew Wade, Julia Prescott, Stephen Neal, David Bryant, Richard Powell, Philip Robinson, Mary Staffurth, John Hughes, Owen Donovan, Jenny L Paul, Alan Hamdy, Freddie C Doherty, Alan Mason, Malcolm Paez, Edgar Rowe, Edward Noble, Sian |
| Author_xml | – sequence: 1 givenname: Freddie C orcidid: 0000-0003-2627-2154 surname: Hamdy fullname: Hamdy, Freddie C organization: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK – sequence: 2 givenname: Jenny L orcidid: 0000-0002-6488-5472 surname: Donovan fullname: Donovan, Jenny L organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 3 givenname: J Athene orcidid: 0000-0002-7578-4925 surname: Lane fullname: Lane, J Athene organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 4 givenname: Malcolm orcidid: 0000-0003-1505-2869 surname: Mason fullname: Mason, Malcolm organization: School of Medicine, University of Cardiff, Cardiff, UK – sequence: 5 givenname: Chris orcidid: 0000-0001-8318-8907 surname: Metcalfe fullname: Metcalfe, Chris organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 6 givenname: Peter orcidid: 0000-0001-9175-4411 surname: Holding fullname: Holding, Peter organization: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK – sequence: 7 givenname: Julia orcidid: 0000-0001-6486-6477 surname: Wade fullname: Wade, Julia organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 8 givenname: Sian orcidid: 0000-0002-8011-0722 surname: Noble fullname: Noble, Sian organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 9 givenname: Kirsty orcidid: 0000-0002-8301-3602 surname: Garfield fullname: Garfield, Kirsty organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 10 givenname: Grace orcidid: 0000-0002-5210-1183 surname: Young fullname: Young, Grace organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 11 givenname: Michael orcidid: 0000-0002-3624-3456 surname: Davis fullname: Davis, Michael organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 12 givenname: Tim J orcidid: 0000-0003-2881-4180 surname: Peters fullname: Peters, Tim J organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 13 givenname: Emma L orcidid: 0000-0003-2575-387X surname: Turner fullname: Turner, Emma L organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 14 givenname: Richard M orcidid: 0000-0002-7992-7719 surname: Martin fullname: Martin, Richard M organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 15 givenname: Jon orcidid: 0000-0002-4348-0273 surname: Oxley fullname: Oxley, Jon organization: Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK – sequence: 16 givenname: Mary orcidid: 0000-0003-3488-3828 surname: Robinson fullname: Robinson, Mary organization: Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK – sequence: 17 givenname: John orcidid: 0000-0002-7834-3172 surname: Staffurth fullname: Staffurth, John organization: Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK – sequence: 18 givenname: Eleanor orcidid: 0000-0001-7696-3661 surname: Walsh fullname: Walsh, Eleanor organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 19 givenname: Jane orcidid: 0000-0002-3354-3330 surname: Blazeby fullname: Blazeby, Jane organization: Bristol Medical School, University of Bristol, Bristol, UK – sequence: 20 givenname: Richard orcidid: 0000-0002-8330-9251 surname: Bryant fullname: Bryant, Richard organization: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK – sequence: 21 givenname: Prasad orcidid: 0000-0001-5912-2772 surname: Bollina fullname: Bollina, Prasad organization: Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK – sequence: 22 givenname: James orcidid: 0000-0003-2787-8828 surname: Catto fullname: Catto, James organization: Academic Urology Unit, University of Sheffield, Sheffield, UK – sequence: 23 givenname: Andrew orcidid: 0000-0002-9131-0623 surname: Doble fullname: Doble, Andrew organization: Department of Urology, Addenbrooke’s Hospital, Cambridge, UK – sequence: 24 givenname: Alan orcidid: 0000-0003-3444-4710 surname: Doherty fullname: Doherty, Alan organization: Department of Urology, Queen Elizabeth Hospital, Birmingham, UK – sequence: 25 givenname: David orcidid: 0000-0003-4581-9346 surname: Gillatt fullname: Gillatt, David organization: Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK – sequence: 26 givenname: Vincent orcidid: 0000-0003-4722-4207 surname: Gnanapragasam fullname: Gnanapragasam, Vincent organization: Department of Urology, Addenbrooke’s Hospital, Cambridge, UK – sequence: 27 givenname: Owen orcidid: 0000-0002-1513-3629 surname: Hughes fullname: Hughes, Owen organization: Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK – sequence: 28 givenname: Roger orcidid: 0000-0003-2261-3628 surname: Kockelbergh fullname: Kockelbergh, Roger organization: Department of Urology, University Hospitals of Leicester, Leicester, UK – sequence: 29 givenname: Howard orcidid: 0000-0003-1902-9930 surname: Kynaston fullname: Kynaston, Howard organization: Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK – sequence: 30 givenname: Alan orcidid: 0000-0001-6467-1864 surname: Paul fullname: Paul, Alan organization: Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK – sequence: 31 givenname: Edgar orcidid: 0000-0002-1168-6736 surname: Paez fullname: Paez, Edgar organization: Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK – sequence: 32 givenname: Philip orcidid: 0000-0001-5215-3613 surname: Powell fullname: Powell, Philip organization: Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK – sequence: 33 givenname: Stephen orcidid: 0000-0002-2737-7364 surname: Prescott fullname: Prescott, Stephen organization: Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK – sequence: 34 givenname: Derek orcidid: 0000-0002-9086-3592 surname: Rosario fullname: Rosario, Derek organization: Academic Urology Unit, University of Sheffield, Sheffield, UK – sequence: 35 givenname: Edward orcidid: 0000-0002-6423-3474 surname: Rowe fullname: Rowe, Edward organization: Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK – sequence: 36 givenname: David orcidid: 0000-0002-6033-5086 surname: Neal fullname: Neal, David organization: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK, Academic Urology Group, University of Cambridge, Cambridge, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32773013$$D View this record in MEDLINE/PubMed |
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| Snippet | Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as... Prostate cancer is the most common cancer in men and is often found through a blood test called a prostate-specific antigen test and through biopsies of the... Background: Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection,... |
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| SubjectTerms | active monitoring Aged Disease-Free Survival Humans Male Middle Aged Patient Reported Outcome Measures Prospective Studies prostate cancer Prostate-Specific Antigen - blood prostate-specific antigen testing Prostatectomy - mortality Prostatic Neoplasms - mortality Prostatic Neoplasms - pathology Prostatic Neoplasms - radiotherapy Prostatic Neoplasms - therapy Quality of Life radical prostatectomy radical radiotherapy radical treatment randomised clinical trial Watchful Waiting |
| Title | Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT |
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