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Largest UK trial of treatment for prostate cancer publishes first results
Active monitoring is as effective as surgery and radiotherapy, in terms of survival at 10 years, reports the largest study of its kind, funded by the National Institute for Health Research (NIHR). Results published in New England Journal of Medicine, show that all three treatments result in similar, and very low, rates of death from prostate cancer. Surgery and radiotherapy reduce the risk of cancer progression over time compared with active monitoring, but cause more unpleasant side-effects. The ProtecT trial, led by researchers at the Universities of Oxford and Bristol in nine UK centres, is the first trial to evaluate the effectiveness, cost-effectiveness and acceptability of three major treatment options: active monitoring, surgery (radical prostatectomy) and radiotherapy for men with localised prostate cancer. Chief investigator, Professor Freddie Hamdy from the University of Oxford, said: “What we have learnt from this study so far is that prostate cancer detected by PSA blood test grows very slowly, and very few men die of it when followed up over a period of 10 years – around 1% – irrespective of the treatment
assigned. This is considerably lower than anticipated when we started the study. “However, treating the disease radically, when found, reduces the number of men who develop spread of prostate cancer, but we do not know yet whether this will make a difference to them living longer or better, and we have been unable to determine reliably which disease is lethal, and which can be left alone.” Between 1999 and 2009, 82,429 men aged 50-69 across the UK were tested and 1,643 diagnosed with localised prostate cancer agreed to be randomised to active monitoring (545), radical prostatectomy (553) or radical radiotherapy (545). The research team measured mortality rates at 10 years, cancer progression and spread, and the impact of treatments reported by men. The research team found that survival from localised prostate cancer was extremely high, at approximately 99%, irrespective of the treatment assigned. The rate of cancer progression and spread was reduced by more than half in men in the surgery and radiotherapy groups, compared with active monitoring; cancer progression occurred in one in five in the active monitoring group, as
opposed to less than one in 10 in the surgery and radiotherapy groups. However, surgery and radiotherapy caused unpleasant side-effects, particularly in the first year after treatment. There was some recovery from side-effects over two to three years. But after six years, twice as many men in the surgery group still experienced urine leakage and problems with their sex life, in comparison with those in the active monitoring and radiotherapy groups. Radiotherapy caused more bowel problems than surgery or active monitoring. Overall quality of life, including anxiety and depression, were not affected by any treatment at any time. Half of the men stayed on active monitoring over the 10-year period and avoided treatment side effects. “This is the first time radiotherapy, surgery and active monitoring treatments for prostate cancer have been compared directly. The results provide patients and clinicians with detailed information about the effects and impacts of each treatment so that they can make an informed decision about which treatment to have,” commented co-investigator Professor Jenny Donovan, from the University of Bristol.
New app could help prevent emergency hospital readmissions
Umotif and the Picker Institute have partnered to create a new healthcare app. Used effectively, the digital platform supports patients to better manage their own care – potentially reducing hospital readmissions rates and improving emergency services in the process.
The light-touch tool, has been designed for patients to use post-discharge, independently and with minimal clinician guidance or involvement. Following a simple invite and registration process, patients are empowered to track their own care experience, including everything from symptoms, recommended
treatments, medication schedules and even a photo and text led progress diary. The aim is to support patient confidence and encourage people to ask more questions about their care journey, by having access to this library of data. During follow-up treatment, it enables transparency and open communication between patients and healthcare staff, preventing any confusion around medication instructions and enhancing the potential for shared-decision making. In addition to the patient empowerment benefits, questions designed by the Picker Institute allow healthcare teams to specifically ask patient
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experience related questions. This data can then be downloaded and collated into digestible reports and channelled into future service improvements.
Philip Stylianides, group director at the
Picker Institute, said: “If you consider that 41% of people were not told key medication side effects, when discharged, you can begin to see why avoidable emergency hospital readmissions are costing the NHS an astounding £1.6 billion per year and rising. Understanding someone’s patient experience is essential for teams’ to learn the strengths and weaknesses of the care they provide.”
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