Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes

The impact of age and functional abilities on estimating safe gaps when crossing roads

A series of observational studies highlighted age differences in road-crossing behaviour of pedestrians, particularly in selecting safe gaps in the traffic. This finding was followed up in a series of experimental studies in which the factors that may influence gap selection decisions were investigated in a simulated road crossing environment. Data on perceptual and cognitive function were also collected. The results showed that distance and time gaps were good predictors of crossing decisions for all age groups (young, young-old and old-old), indicating that even the oldest pedestrians seem to be able to process concurrent information about the distance and speed of approaching vehicles in order to estimate time gaps. It was also found that many older adults made risky decisions when compared with predicted responses based on walking time. In addition, some association between performance on physical, perceptual and cognitive skills and road crossing responses were found. The results are discussed in terms of age-related perceptual and cognitive limitations and the ability to compensate for these limitations

Age differences in road crossing decisions based on gap judgements

Abstract not available

Road crossing behaviour of older pedestrians

Older pedestrians are over-represented in serious-injury and fatal road crashes. In these studies the possibility that this over-representation is at least in part due to differences in road-crossing behaviour was investigated. Three groups of pedestrians were unobtrusively and anonymously observed when they were crossing busy one-way and two-way roads mid-way between traffic lights. The “young“ group ranged in estimated age from 30-45 years, the “young-olds“ from 60-69 years and the “old-olds“ were estimated to be 75 and older. The results showed that old-old pedestrians in particular seem to be at increased risk of colliding with a vehicle on a two-way road because in comparison with young pedestrians they are on the road for longer (slower walking), they cross roads more often when there is on-coming traffic in the far lane, and while they seem to compensate for slow walking by leaving larger distance gaps, they do not leave larger time gaps between themselves and the oncoming vehicle. This risk is reduced on one-way roads and for young-old pedestrians. It seems that on a more complex road, old-old pedestrians have difficulties processing concurrently multiple sources of information: traffic in both directions and speed and distance of oncoming vehicles

Smoking prevention in Bristol: Getting maximum results using minimum resources

An account is given of smoking prevention initiatives undertaken by two members of the health education service in Avon over the last four years. The diversity, practicality and effectiveness of such initiatives is emphasised, in the hope that similar strategies maybe adopted by other health education units. © 1985, Sage Publications. All rights reserved