Prostate cancer found by PSA testing: what a 15-year study tells us

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If a PSA test leads to a diagnosis of early prostate cancer, one of the first questions is whether to treat it right away. A large study called ProtecT helps answer that question.

What the study did

In the UK, more than 82,000 men aged 50 to 69 had a PSA test. Of the men found to have prostate cancer that had not spread, 1,643 agreed to take part. Each man was put into one of three groups by chance:

• Active monitoring. Regular PSA tests, with treatment only if the cancer seemed to be growing.
• Surgery to remove the prostate.
• Radiation treatment.

The researchers then followed the men for about 15 years.

What they found

• Very few men died of prostate cancer. It happened to about 2 to 3 in 100 men in each group. The difference between the groups was so small it could have been due to chance.
• Deaths from any cause were similar in all three groups.
• The cancer was more likely to grow or spread with monitoring. Cancer spread to other parts of the body in about 9 in 100 men in the monitoring group, compared with about 5 in 100 in each treatment group.
• About 1 in 4 men in the monitoring group never needed treatment during the study.

What this means for you

For most men with prostate cancer found early, the risk of dying of it over 15 years is low, whatever treatment they choose. The choice involves weighing the benefits of treatment against its side effects. That is why your urologist will talk through all your options with you, including watching the cancer closely.

Monitoring in this study was based mostly on PSA tests. Today, close watching of low-risk prostate cancer (called active surveillance) usually adds MRI scans and repeat biopsies when needed. You can read more on our page about elevated PSA.

This is a summary of published research for general information. It is not medical advice. Talk with your own doctor about your situation.

Source: Hamdy FC et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med 2023;388:1547-1558. doi:10.1056/NEJMoa2214122

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