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"Focused on the Prostate since 1996"

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

The Medical Research Council Prostate Cancer Working Party Investigators Group.
British Journal of Urology 1997, 79: 235-246.

This important study was first reported at BAUS in Edinburgh last year. Patients with locally advanced or
asymptomatic metastatic prostate cancer (n=938) were randomised either to immediate orchiectomy/LHRH
analogue or to the same treatment deferred until an indication occurred. Progression from M0 to M1 disease and
development of metastatic pain occurred more rapidly in deferred patients. Moreover, complications including
need for TURP, pathological fracture, spinal cord compression, ureteric obstruction and development of
extra-skeletal metastases were twice as common in the deferred arm. For 29 patients in the deferred arm, the
first complication was death! i.e. these patients died of untreated prostate cancer. These results imply that there is
now little justification deferring hormone therapy in patients diagnosed with metastatic disease. This paper is
definitely worth reading - it is likely to be quoted for some time. One must remember however that there was no
systematic follow-up of patients with prostate cancer and so many patients died or suffered complications without
ever receiving treatment. Regular follow up may pick up the need for treatment before complications and avoid
the adverse effects of early treatment initiated before it is necessary.