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Prostate Cancer Treatment and Research / Prostate Cancer Diagnosis and Treatment / Multiple and Secondary Primary Cancers · Journal article
British Journal of Urology · August 12, 2026
Well-designed and adequately powered for the question it asks.
This prospective population-based cohort of 2604 men with localised prostate cancer followed for 10 years reports low prostate cancer-specific mortality (≤1.5% in favourable-risk group, 3.5–8.8% in unfavourable-risk group) across five contemporary treatment strategies including active surveillance. While surgery was associated with superior overall survival compared to radiotherapy and active surveillance, the authors attribute this to residual confounding from baseline health and treatment selection rather than treatment effect, and emphasise that shared decision-making should incorporate patient values and comorbidities.
Prospective population-based cohort study, stratified by prognostic risk. Men with clinically localised prostate cancer (cT1–T2cN0M0, PSA ≤50 ng/mL, Grade Group 1–5) enrolled from a population-based United States cohort 2011–2012; 73% White, 15% Black, 7% Hispanic.. Intervention: External beam radiotherapy (EBRT), brachytherapy, or active surveillance (compared to surgery as reference).. Compared with: Radical prostatectomy (surgery) as the reference treatment.. n = 2,604. United States, population-based cohort (specific centres or states not detailed in abstract)..
In favourable-prognosis group, 10-year cumulative incidence of prostate cancer-specific mortality ≤1.5% for all five treatment strategies. In unfavourable-prognosis group, 10-year cumulative incidence of prostate cancer-specific mortality 3.5% after surgery versus 8.8% after EBRT; no adjusted difference in PCSM across treatments. Surgery associated with lower all-cause mortality than EBRT (HR 2.8, 95% CI 1.9–4.3, P < 0.01) in unfavourable group; similar OS advantage for surgery in favourable group (EBRT HR 1.5, 95% CI 1.1–2.1; brachytherapy HR 2.1, 95% CI 1.3–3.3; active surveillance HR 1.5, 95% CI 1.1–2.1).
Enrollment 2011–2012 with 10-year follow-up; some participants may not have completed full 10-year observation, and mortality competing risks are acknowledged for PCSM but competing-risk analysis (Fine-Gray) results for PCSM not detailed for all comparisons. In favourable-prognosis group, 10-year cumulative incidence of prostate cancer-specific mortality ≤1.5% for all five treatment strategies.
Clinicians counselling men with localised prostate cancer should recognise that prostate cancer-specific mortality is low across contemporary treatment options (surgery, EBRT, brachytherapy, active surveillance) at 10 years, particularly in favourable-risk disease. The observed overall survival advantage for surgery likely reflects confounding by baseline health status and treatment selection rather than a treatment effect; treatment choice should prioritise patient values, comorbidity burden, and functional outcomes alongside oncological risk.
Population-based prospective cohort with long-term follow-up (10 years) and hard clinical outcomes (prostate cancer-specific mortality, overall survival) across multiple treatment modalities, though observational design and residual confounding limit causal inference.
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Quoted from the source exactly as published.
Clinicians counselling men with localised prostate cancer should recognise that prostate cancer-specific mortality is low across contemporary treatment options (surgery, EBRT, brachytherapy, active surveillance) at 10 years, particularly in favourable-risk disease. The observed overall survival advantage for surgery likely reflects confounding by baseline health status and treatment selection rather than a treatment effect; treatment choice should prioritise patient values, comorbidity burden, and functional outcomes alongside oncological risk.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
OBJECTIVES: To report long-term oncological outcomes for men with clinically localised prostate cancer (PCa) treated with contemporary modalities in a population-based United States cohort. PATIENTS AND METHODS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study prospectively enrolled men with clinically localised PCa from 2011 to 2012. Patients were stratified into two groups: favourable prognosis (clinical T stage [cT]1-T2a/bN0M0, prostate-specific antigen [PSA] level ≤ 20 ng/mL, Grade Group 1-2) and unfavourable prognosis (cT2cN0M0, PSA level 20-50 ng/mL, or Grade Group 3-5). Main outcomes were PCa-specific mortality (PCSM), composite progression to advanced disease (metastasis, PCSM event, or systemic therapy), and overall survival (OS). Cox regression models adjusted for demographic and clinical covariates. RESULTS: Of the 2604 men included, 73% were White, 15% Black, and 7% Hispanic. All hazard ratios (HRs) were adjusted for demographic and clinical covariates using multivariable Cox and Fine-Gray models. In the favourable group, compared with surgery, external beam radiotherapy (EBRT; HR 1.5, 95% confidence interval [CI] 1.1-2.1, P < 0.01), brachytherapy (HR 2.1, 95% CI 1.3-3.3, P < 0.01), and active surveillance (HR 1.5, 95% CI 1.1-2.1, P = 0.02) were associated with higher all-cause mortality; the 10-year cumulative incidence of PCSM was ≤1.5% for all five strategies, and progression did not differ. In the unfavourable group, EBRT was associated with worse OS (HR 2.8, 95% CI 1.9-4.3, P < 0.01), with no adjusted differences in PCSM (10-year cumulative incidence 3.5% after surgery vs 8.8% after EBRT) or progression across treatments. CONCLUSION: In this population-based cohort treated with contemporary modalities, the 10-year risk of PCa death was low across all treatment strategies, including active surveillance. OS differences favouring surgery likely reflect residual confounding from baseline health and treatment selection. These findings underscore the importance of patient values and comorbidities in shared decision-making for localised PCa.
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