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Updated: Mar 15, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer
Freddie C Hamdy1, Jenny L Donovan1, J Athene Lane1
1From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom.
Prostate cancer treatments including active monitoring, surgery, and radiotherapy showed similar survival rates over 10 years. However, surgery and radiotherapy led to lower rates of disease progression and metastases compared to active monitoring.
Area of Science:
- Oncology
- Urology
- Clinical Trials
Background:
- Uncertainty exists regarding the comparative effectiveness of prostate cancer treatments detected via prostate-specific antigen (PSA) testing.
- Localized prostate cancer management options include active monitoring, radical prostatectomy, and external-beam radiotherapy.
Purpose of the Study:
- To compare the effectiveness of active monitoring, radical prostatectomy, and external-beam radiotherapy for localized prostate cancer.
- To evaluate prostate-cancer-specific mortality, disease progression, metastases, and all-cause deaths as outcomes.
Main Methods:
- A randomized controlled trial involving 1643 men diagnosed with localized prostate cancer between 1999 and 2009.
- Participants were randomized to active monitoring (545), surgery (553), or radiotherapy (545).
- Median follow-up was 10 years, with prostate-cancer-specific mortality as the primary outcome.
Main Results:
- No significant difference in prostate-cancer-specific mortality was observed among the three treatment groups (P=0.48).
- All-cause mortality also showed no significant difference between groups (P=0.87).
- Active monitoring was associated with significantly higher rates of disease progression (P<0.001) and metastases (P=0.004) compared to surgery and radiotherapy.
Conclusions:
- Prostate-cancer-specific mortality is low and similar across active monitoring, surgery, and radiotherapy for localized prostate cancer at 10-year follow-up.
- Radical prostatectomy and external-beam radiotherapy demonstrate superior outcomes in terms of reduced disease progression and metastasis incidence compared to active monitoring.
