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

Abstract

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 PPP=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.