Randomized Comparison of Surgery, Radiotherapy, and Surveillance for Prostate Cancer

Whether patients should undergo screening for prostate cancer remains controversial. When patients elect screening and are found to have localized cancer, they essentially have three options — surgery, radiotherapy, or monitoring. In 2016, the first randomized comparison of these options, the “Protec T” trial, was published. In this U.K. trial, 1643 middle-aged men (age range, 50–69) underwent either radical prostatectomy, radiation therapy with neoadjuvant androgen-deprivation therapy, or active surveillance (i.e., prostate-specific antigen [PSA] testing every 3–6 months, and review for possible treatment when PSA rose by 50% during 12 months). Baseline Gleason score was 6 in most patients (NEJM JW Gen Med Nov 1 2016 and N Engl J Med 2016;…