Dr. Anthony Zeitman on Radiation vs. Surgery for High Risk Patients

https://www.youtube.com/watch?v=c6oLwxcneaY

Speaking in 2014, notice that Dr. Zeitman (at 8:56) says, with respect to the issue of which is superior, "don't let anyone tell you that they know, because they don't."

Dr. Zeitman says, again in 2014, that we will know with the results of the ProTECT UK trial (which was completed in 2015).

Here is a link to the results of the ProTECT trial:

http://www.nejm.org/doi/full/10.1056/NEJMoa1606220#t=article

compare the results for yourself.

Thanks for posting that, IndividualizedTx. As I read it there is a sharp difference whether treated or not - with triple the number on active surveillance progressing to metastases despite half of that cohort eventually choosing to do the primary surgery or radiation.

Active surveillance is a great option - postponing or avoiding the side effect of primary therapy. But it is a roll of the dice for younger and otherwise healthy individuals. 10 year mortality is not a meaningful metric for PCa. Better to look at QOL and 20 or 25 year mortality.

As others have observed, there have been important advances in radiation since this study.

Best to all -
Wilderness

To expand on what JackH wrote, the results of the PROTECT trial are meaningless with respect to the no-treatment ("monitored") group because this group was not in an active surveillance protocol as currently practiced in the USA.

There has been an extensive discussion of this earlier on this forum, but I can't find the thread.