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November 2017

To ProtecT Our Patients With Prostate Cancer

Author Affiliations
  • 1Department of Radiation Oncology, University of Michigan, Ann Arbor
JAMA Oncol. 2017;3(11):1461-1462. doi:10.1001/jamaoncol.2017.0274

The authors of the recent Prostate Testing for Cancer and Treatment (ProtecT) trial should be commended for their Herculean effort not only to perform and complete a large randomized trial but also to demonstrate the feasibility of randomizing patients with prostate cancer to various treatment strategies (surgery, radiotherapy, and active monitoring).1,2 However, it is fascinating that despite the results of prior studies, such as the Prostate Cancer Intervention vs Observation Trial (PIVOT), and now ProtecT, which both demonstrated no difference of immediate radical treatment on prostate cancer–specific or overall survival for predominantly favorable-risk patients, that the conclusions drawn by the accompanying editorial were that “if a man wishes to avoid metastatic prostate cancer and the side effects of its treatment, [active] monitoring should be considered only if he has life-shortening coexisting disease.”3(p1483) This is especially interesting given that the use of nerve-sparing radical prostatectomy has been demonstrated in multiple large randomized trials, including ProtecT, to result in approximately 70% of baseline potent men to not be able to achieve erections firm enough for intercourse, and 20% of men having long-term urinary incontinence requiring the use of at least 1 pad per day.1 Furthermore, the use of radical radiotherapy and androgen deprivation therapy demonstrated that approximately 50% of baseline potent men lost the ability to have functional erections 2 years after treatment, and experienced an increased incidence of rectal bleeding.

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