EURURO Vol. 72 No. 3

470 476

Words of Wisdom
Re: 10-Year Outcomes After Monitoring, Surgery or
Radiotherapy for Localized Prostate Cancer
Hamdy FC, Donovan JL,[1_TD$DIFF] Lane JA, et al
N Engl J Med 2016; 375:1415–24
Expert’s summary:
This combined screening and treatment trial evaluated the
efficacy of prostate-specific antigen (PSA) in altering prostate
cancer mortality using one of three contemporary treatment
approaches. The authors offered a single PSA screen to 82
429 men aged 50–69 yr with no previous PSA measurement
over a period of 10 yr. They identified 2664 men with primar-
ily Gleason 6 and 7 disease. All of these men were asked to
participate in a randomized trial comparing surgery, radiation,
and active monitoring, and 1643 (62%) agreed to participate.
After median follow-up of 10 yr, there were 17 prostate
cancer–specific deaths: eight in the active monitoring group,
five in the surgery group, and four in the radiation group.
These results did not differ significantly (p = 0.48). Deaths
from any cause were also equally distributed among the three
groups (p = 0.87). Disease progression occurred more fre-
quently in the active monitoring group (n = 112) than in the
surgery group (n = 46) or the radiation group (n = 46;
p = 0.004)
Expert’s comments:
This is the largest randomized trial ever conducted to test the
efficacy of contemporary prostate cancer management
. Patient recruitment was unusual in that the investiga-
tors relied on population-based screening to identify men
with localized disease. Their efforts showed that PSA testing
primarily identifies men with Gleason 6 disease and some
men with Gleason 7 disease; men with high-grade prostate
cancer are found infrequently. The authors demonstrated that
most screen-detected cancers have a natural history of at least
10 yr. Surgery and radiation offer some protection against
disease progression, but the number of men who did progress
within 10 yr represented only 20% of the total number ran-
domized to active monitoring. This suggests that the natural
history of low-grade prostate cancer may be 15–20 yr or
longer .
During the 10-yr follow-up, just over half of the men in
the active monitoring arm elected to undergo treatment:
half elected for surgery and half for some form [3_TD$DIFF]of radiation
or ablative therapy. How these men differed from those
electing to remain on active monitoring is uncertain. Their
outcomes, however, did not differ from those men who
received immediate treatment, which therefore supports
the concept of active surveillance for men with low-grade
disease. Finally, the trial confirmed that surgery and
radiation are equally effective over 10-yr follow-up. Readers
should remember that these[2_TD$DIFF] results are preliminary; 15-yr
outcomes are anxiously awaited.
Conflicts of interest: The author has nothing to disclose.
References
[1]
[2]
[3]
[4]
Peter C. Albertse
Division of Urology, University of Connecticut Health Center,
Farmington, CT, USA
*Division of Urology, University of Connecticut Health Center,
263 Farmington Avenue, Farmington, CT 06030, USA.
E-mail address:
# 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Re: Diagnostic Accuracy of Ga-68-HBED-CC-PSMA-
ligand-PET/CT Before Salvage Lymph Node Dissection
for Recurrent Prostate Cancer
Jilg CA, Drendel V, Rischke HC, et al
Theranostics 2017;7:1770–80
Experts’ summary:
This study reports results for targeted versus extended salvage
lymphadenectomy after prostate-specific membrane antigen–
targeted positron emission tomography/computed tomogra-
phy (PSMA-PET/CT) in 30 men with biochemical recurrence of
available at
journal homepage:
0302-2838/