AUA 2017: The ERSPC Versus The ProtecT Study: Outcomes After Active Surveillance Compared to Surgery and Radiotherapy for Localized Prostate Cancer

Boston, MA ( The long-term safety of active surveillance (AS) remains a controversial topic of debate. The ProtecT Study published 10-year outcomes after randomization to active monitoring (AM), radiotherapy (RT), or radical prostatectomy (RP); with higher-risk patients and a less strict follow-up protocol than contemporary AS. In the European Randomized study of Screening for Prostate Cancer (ERSPC) Rotterdam, a subgroup of patients also received AM/AS, although it was utilized according to a more strict protocol (eg, Prostate Cancer Research International Active Surveillance or PRIAS).

Dr. Frank-Jan Drost presented a study evaluating death rates among men with low- to intermediate-risk prostate cancer (PC) treated with AS, RT, or RP in the ERSPC and compared these with ProtecT patients. Men with low-risk (Gleason score [GS] 6, cT1C/cT2A) and intermediate-risk (GS ≤3+4, cT1c/cT2) PC, diagnosed in the first and second screening rounds of the ERSPC study (1993-2003) were included. Multivariate Cox proportional hazard analyses were performed, controlling for age, prostate-specific antigen, clinical stage, GS, and comorbidities.

Of the 2280 PC patients from the ERSPC who were analyzed, 905 and 1275 had low- and intermediate-risk PC, respectively. Median age and prostate-specific antigen in the low- and intermediate-risk PC were 66.4 years and 4.3 ng/mL; 66.6 years and 4.5 ng/mL, respectively. Median follow-up was 13 years. In the low-risk group, the hazard ratio (HR) for PC-specific death for RT/RP (n = 370/312) versus AS (n = 223) was 0.61 (95% confidence interval [CI] 0.18-2.0, P = .41). The HR for overall death was 1.29 (95% CI 0.97-1.72). In the intermediate-risk group, the HR for PC-specific death for RT/RP (n = 501/526) versus AS (n = 248) was 0.65 (95% CI 0.25-1.64, P = .36). The HR for overall death was 1.23 (95% CI 0.95-1.59).

In the ProtecT study, the HR for PC-specific death for RT versus AM was 0.51 (95% CI 0.15-1.69) and for RP versus AM 0.63 (95% CI 0.21-1.93), P = .48. The specific HR for overall death was not specified (P = .87 across treatment groups).

In summary, the HR for PC-specific death for AS versus immediate active therapy between the ERSPC Rotterdam and ProtecT appear to be quite similar. Although the ERSPC was not randomized but did include 13 years of complete follow-up, these data confirm that initial therapy with AS, when compared with immediate active therapy, results in similar low PC-specific death rates.

Presented By: Frank-Jan Drost, Rotterdam, Netherlands

Co-Authors: Noah Canvasser, MD; Aaron Lay, MD; Shuvro De, MD; Arthi Satyanarayan, MD; Elysha Kolitz, MD; Margaret Pearle, MD, PhD; Jodi Antonelli, MD

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Twitter: @goldberghanan

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA