Immediate versus deferred treatment for advanced prostatic cancer: Initial results of the Medical Research Council trial

Adib, R.S. and Anderson, J.B. and Ashken, M.H. and Baumber, C.D. and Bevis, C.R.A. and Beynon, L.L. and Blaxland, J.W. and Boag, V. and Bolger, J.J. and Boreham, J. and Bramble, F.J. and Breakey, J. and Bullock, K.N. and Burrett, J. and Carswell, G.F. and Charlton, C.A.C. and Chilton, C.P. and Chisholm, G.D. and Clack, R. and Claridge, M. and Clark, P.B. and Coulton, E.R. and Cox, S.R. and Cresswell, S.M. and Crowther, J. and Davies, M. and DeSousa, B.A. and Deane, R.F. and Devereux, M.H. and Doyle, P.T. and English, P. and Evans, C.M. and Fellows, G.J. and Fernie, C.G.M. and Fordham, M. and French, M.E. and Gaches, C.G.C. and Gallegos, C.R.R. and Gilliland, E.L. and Glaholm, J. and Glashan, R.W. and Grant, J.B.P. and Grayson, C.E.A. and Green, N.A. and Griffin, S. and Hall, R.R. and Hafner, B. and Hargreave, T.B. and Harrison, G.S.M. and Heal, M.R. and Hehir, M. and Hetherington, J. and James, M.J. and Jones, P.A. and Jones, R.A. and Jurczyk, L.N. and Kirk, D. and Knight, S. and Lawrence, W.T. and Logie, J.R.C. and Lucas, M. and Luck, R.J. and McGregor, A. and McKelvie, G.B. and Moffat, L.E.F. and Moore, K.T.H. and Morgan, R.J. and Newling, D.W.K. and Orr, P.G.G. and Parish, S. and Perry, K. and Peto, R. and Pollard, R. and Powell, C.S. and Radley, A. and Rampling, R. and Rennie, C.D. and Rhind, J.R. and Richards, B. and Roberts, C. and Robinson, M.R.G. and Rogers, A.C.N. and Rose, M.B. and Ross, R.T.A. and Royle, M.G. and Sagar, S. and Sethia, K.K. and Shearer, R.J. and Shepheard, B.G.F. and Smith, J. and Smith, J.C. and Smith, M.F. and Smith, P.H. and Sole, G.M. and Stephenson, T.P. and Stewart, A.L. and Stower, M.J. and Styles, R.A. and Thomson, R.W. and Thompson, E. (1997) Immediate versus deferred treatment for advanced prostatic cancer: Initial results of the Medical Research Council trial. British Journal of Urology, 79 (2). pp. 235-246. ISSN 0007-1331. (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

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Objective To compare the effect on the course of advanced prostate cancer of hormone treatment commenced on diagnosis with that deferred until clinically significant progression occurs. Patients and methods Nine hundred and thirty-eight patients with locally advanced or asymptomatic metastatic prostate cancer were randomized either to immediate treatment (orchidectomy or luteinizing hormone-releasing hormone analogue) or to the same treatment deferred until an indication occurred, Follow-up and management were otherwise according to the participating clinician's normal practice. Information was collected annually on survival, local and distant progression, and major complications (pathological fracture, spinal cord compression, ureteric obstruction and extra-skeletal metastases). Results Follow-up data were returned on 934 patients; 51 deferred patients died from causes other than prostate cancer before treatment was started (but only five of these presented at age <70 years) and 29 died from prostate cancer before treatment could be started, Treatment was commenced for local progression almost as frequently as for metastatic disease, Progression from M0 to M1 disease (P<0.001, two-tailed) and development of metastatic pain occurred more rapidly in deferred patients; 141 deferred patients needed transurethral resection for local progression compared with 65 treated immediately (P<0.001, two-tailed). Pathological fracture, spinal cord compression, ureteric obstruction and development of extra-skeletal metastases were twice as common in deferred patients. Of the patients who died, 67% did so from prostate cancer; 361 patients died in the deferred arm compared with 328 in the immediate arm (P=0.02, two-tailed), where 257 and 203 were deaths from prostate cancer, respectively (P=0.001 two-tailed). This difference was seen largely in M0 patients, with 119 and 81 deaths from prostate cancer, respectively (P<0.001 two-tailed). Conclusions The results consistently favour immediate treatment, although some of the data, especially on M0 patients, are immature. The implications for management of advanced prostate cancer are discussed.

Item Type: Article
Uncontrolled keywords: prostate cancer; hormone treatment; deferred treatment
Depositing User: T. Nasir
Date Deposited: 29 Oct 2009 19:05
Last Modified: 29 Oct 2009 19:05
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