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Delaying therapeutic intervention for localized prostate cancer does not increase the risk of mortality, but on the contrary, patients undergoing active surveillance may have the same 15-year survival rates as those undergoing radiotherapy or surgery.

This is the conclusion of a new, long-term study, which highlights the catalytic role that the contribution of specialized Oncologists and Radiation Therapists, alongside that of the Surgeon-Urologist, has in the successful management of the disease.

The ProtecT study is an important randomized study that evaluates the effectiveness of different therapeutic options for localized prostate cancer, and the results of the 15-year follow-up were recently announced at the European Society of Urology Congress in Milan. The findings from the ProtecT trial have important implications for the management of localized prostate cancer and have the potential to change clinical practice.

Prostate cancer is the most common cancer in men and is most often diagnosed at an early stage, when the cancer is still within the prostate gland. The management of localized prostate cancer presents significant challenges, as there are several treatment options available, including active surveillance (which includes tests to check for prostate cancer), radical prostatectomy and radical radiotherapy. The optimal treatment strategy for localized prostate cancer remains a matter of debate, and the ProtecT trial aimed to provide answers to this question.

The ProtecT trial was a randomized study that included 2,664 men with localized prostate cancer diagnosed between 1999 and 2009. They were randomized to one of three arms of the study: active surveillance, radical prostatectomy, or radiotherapy. The primary endpoint of the trial was prostate cancer mortality.

Low mortality

The results of the 15-year follow-up of the ProtecT trial showed that prostate cancer mortality was low in all treatment arms, with no statistically significant difference between the groups. It was found that about 97% of men diagnosed with prostate cancer survived 15 years after diagnosis, regardless of the treatment they received, while about a quarter of men on active surveillance had not yet undergone invasive treatment for their cancer after 15 years. The 15-year prostate cancer-specific mortality rates were 1.5%, 0.9% and 0.9% in the active surveillance, radical prostatectomy and radiotherapy arms, respectively. These findings suggest that all three treatment options are effective in reducing prostate cancer-related mortality.

However, the ProtecT trial identified some differences in the rates of disease progression and metastasis between the treatment arms. Men who underwent radical prostatectomy had a lower risk of disease progression compared with those who underwent active surveillance or radiation therapy. In addition, men who underwent radiation therapy had a higher risk of metastasis compared with those who underwent active surveillance or radical prostatectomy. The study also found that the negative effects of radiation therapy and prostatectomy on the urinary tract and sexual function persist much longer than previously thought – for up to 12 years.

The results of the ProtecT trial are likely to lead to a change in clinical practice, with clinicians and patients more carefully considering the potential benefits and risks of each treatment option. The trial findings will also contribute to the development of new clinical guidelines for the management of localized prostate cancer.

At the Athens Medical Center, prostate cancer cases are managed with the most modern practices and the most advanced technological means, taking into account the recommendations of an Oncologist who specializes in this disease.

In particular, with regard to the diagnosis of the disease, the possibility of multiparametric prostate MRI and fusion biopsy is provided, which is the most accurate diagnostic procedure for prostate cancer, as well as PSMA PET/CT for initial assessment of locally advanced disease and reassessment in case of biochemical recurrence, i.e. a new increase in the PSA index.

Regarding the treatment of prostate cancer In addition, the Athens Medical Group is also pioneering by providing the possibility of Focal One focal therapy, where appropriate, and robotic prostatectomy for radical treatment of the disease,

In conclusion, the diagnosis of localized prostate cancer, unlike many other types of cancer, should not cause panic in patients and thus lead them to make wrong treatment choices. They should always discuss their case, in addition to the Urologist, with a specialized Pathological Oncologist and Radiation Therapist (within the framework of the Oncology Council), so that the advantages and disadvantages of each treatment strategy can be studied. They should always keep in mind that their choice will not affect their survival, as the ProtecT study showed.