Localized Prostate Cancer: Randomized Comparison of Surgery, Radiotherapy, and Active Surveillance

Researchers have compared radical prostatectomy and watchful waiting in men with localized prostate cancer in two large randomized trials (NEJM JW Gen Med Apr 1 2014 and N Engl J Med 2014; 370:932; NEJM JW Gen Med Aug 15 2012 and N Engl J Med 2012; 367:203). Now, U.K. researchers report findings from a three-arm randomized trial in which 1643 men (age range, 50–69) with prostate-specific antigen (PSA)–detected cancer received radical prostatectomy, radiotherapy plus neoadjuvant androgen-deprivation therapy, or active surveillance. At trial entry, mean age was 62, median PSA level was 4.8 ng/mL, and 77% of participants had Gleason scores of 6. Active surveillance involved PSA testing every 3 to 6 months, and a 50% rise in PSA levels during 1…