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The treatment options which balance harm against good with men diagnosed with prostate cancer after prostate-specific antigen (PSA) screening continue to be a huge debate. Now a major new study from the UK sheds light on the different paths available to men.

In the study, researchers followed more than 80,000 men who were between the ages of 50 and 69, and had received a PSA test in the decade between 1999 and 2009. A localised prostate cancer was diagnosed in 2664 of these men, and of those about 1600 were randomised into one of three treatment groups – active surveillance, prostatectomy and radiotherapy. Participants were followed for a median of 15 years.  The primary focus of the study was death from prostate cancer, while secondary outcomes measured include death from any cause, disease progression and metastases.

The researchers found that death from prostate cancer occurred in 45 men – 17 in the active surveillance group, 12 in the prostatectomy group and 16 in the group receiving radiotherapy. Any-cause mortality occurred in 356 men, with a similar split among all treatment groups. Men receiving active surveillance were more likely to have their cancer metastasise and show clinical progression.

Despite this, the main finding of this study is that death rates due to prostate cancer are low and didn’t vary by treatment choice. The research suggests men with a diagnosis of localised, low-risk prostate cancer need to consult with their treatment team about the benefits and risks of each of the options available to them and decide based on their personal values and expectations.

Speaking on ABC Radio National’s Health Report, Professor Jenny Donovan from the University of Bristol, who was one of the researchers, said “Our findings are particularly relevant for men with low and intermediate risk prostate cancer, as they’re called now, those are the most common after PSA testing. If men have higher risk disease or advanced disease, then they need treatment straightaway. But for men with low and intermediate risk, localised prostate cancers, they have time to decide what to do about their treatment, because they’re going to live long lives. We showed 97% survival at 15 years”.

Dr Norman Swan highlighted that statistics in Australia suggest that 7 out of 10 men with such a prostate cancer choose active monitoring rather than treatment.

“There are also a large group of men in the intermediate risk group who could also consider active monitoring. They would obviously need to discuss that with their clinicians,“ Professor Donovan added.

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