The ProtecT trial1 has provided the medical community with Level I evidence that there is no difference in prostate cancer–specific mortality among radical prostatectomy, radiation therapy, and active surveillance at 10-year follow-up for patients with low-risk (Gleason 6) and intermediate-risk (Gleason 7) prostate cancer. Should this data be applied to all patients with low or intermediate risk prostate cancer? For some in the oncology community, it has resulted in dramatic changes in the standard of care, while others have resisted the ProtecT implications of active surveillance being comparable to radical prostatectomy or radiotherapy for patients with low-risk and intermediate-risk prostate cancer.2,3 There are significant limitations that should be addressed with patients at the time of multidisciplinary consultation and discussion of treatment options so that patients can make the most informed decision. These limitations particularly apply to young and nonwhite patients with prostate cancer; when patients are counseled regarding the treatment-related adverse effects of definitive treatment options, they should also realize that uncertainty of outcomes beyond the 10 years of currently published results is the risk associated with active surveillance as a treatment modality.
McClelland S, Mitin T. The Danger of Applying the ProtecT Trial to Minority Populations. JAMA Oncol. 2018;4(3):291. doi:10.1001/jamaoncol.2017.5452
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