What effect does each treatment option have on survival at 10 years?

The evidence does not show a difference in the number of deaths from prostate cancer among people offered active surveillance, surgery to remove the prostate or radiotherapy.
People who had not died of prostate cancer were:

  • 98 out of 100 patients offered active surveillance
  • 99 out of 100 patients offered surgery to remove the prostate
  • 99 out of 100 patients offered radiotherapy.

What effect does each treatment option have on the cancer returning or growing (disease progression) at 10 years?

There is good evidence that both surgery to remove the prostate and radiotherapy reduce the risk of the cancer returning or growing (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 surgery to remove the prostate
  • 8 out of 100 patients offered radiotherapy.

The ProtecT trial defined disease progression as:

“Evidence of metastases or diagnosis of clinical T3 or T4 disease or need for long-term androgen deprivation therapy or rectal fistula or the need for a urinary catheter owing to local tumour growth.”

Disease progression was suspected if there was:

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

What effect does each treatment option have on the risk of the cancer spreading (distant metastases) at 10 years?

There is good evidence that both surgery to remove the prostate and radiotherapy reduce the risk of the cancer spreading (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 surgery to remove the prostate
  • 3 out of 100 patients offered radiotherapy.

There is some evidence that urinary function is better for people offered active surveillance or radiotherapy than those offered surgery to remove the prostate.

At 6 months, problems with urinary continence were reported in:

  • 39 out of 100 patients offered active surveillance
  • 71 out of 100 patients offered surgery to remove the prostate
  • 38 out of 100 patients offered radiotherapy.

At 6 years, problems with urinary continence were reported in:

  • 50 out of 100 patients offered active surveillance
  • 69 out of 100 patients offered surgery to remove the prostate
  • 49 out of 100 patients offered radiotherapy.

At 6 months, moderate to severe urinary incontinence problems were reported in:

  • 4 out of 100 patients offered active surveillance
  • 19 out of 100 patients offered surgery to remove the prostate
  • 6 out of 100 patients offered radiotherapy.

At 6 years, moderate to severe urinary incontinence problems were reported in:

  • 8 out of 100 patients offered active surveillance
  • 13 out of 100 patients offered surgery to remove the prostate
  • 5 out of 100 patients offered radiotherapy.

What effect does each treatment option have on bowel function?

There is some evidence that bowel function is better for people offered active surveillance or surgery to remove the prostate than those offered radiotherapy in the short term.

At 6 months, problems with faecal incontinence more than once per week were reported in:

  • 2 out of 100 patients offered active surveillance
  • 1 out of 100 patients offered surgery to remove the prostate
  • 5 out of 100 patients offered radiotherapy.

At 6 years, problems with faecal incontinence more than once per week were reported in:

  • 3 out of 100 patients offered active surveillance
  • 2 out of 100 patients offered surgery to remove the prostate
  • 4 out of 100 patients offered radiotherapy.

At 6 months, moderate to severe impact of bowel habits on quality of life was reported in:

  • 3 out of 100 patients offered active surveillance
  • 3 out of 100 patients offered surgery to remove the prostate
  • 10 out of 100 patients offered radiotherapy.

At 6 years, moderate to severe impact of bowel habits on quality of life was reported in:

  • 4 out of 100 patients offered active surveillance
  • 3 out of 100 patients offered surgery to remove the prostate
  • 2 out of 100 patients offered radiotherapy.

What effect does each treatment option have on sexual function?

There is some limited evidence that sexual function is better for people offered active surveillance or radiotherapy than those offered surgery to remove the prostate.

At 6 months, moderate or severe problems with sexual function were reported in:

  • 29 out of 100 patients offered active surveillance
  • 66 out of 100 patients offered surgery to remove the prostate
  • 48 out of 100 patients offered radiotherapy.

At 6 years, moderate or severe problems with sexual function were reported in:

  • 40 out of 100 patients offered active surveillance
  • 50 out of 100 patients offered surgery to remove the prostate
  • 36 out of 100 patients offered radiotherapy.

The information given on survival, disease progression and side effects is taken from the NICE guidelines and is based on evidence from a large UK trial (ProtecT).

Visit the protect trial.