Men with localized prostate cancer have similar rates of prostate cancer−specific death 10 years after diagnosis, regardless of whether they receive radiotherapy, surgery, or active monitoring (ie, watchful waiting), according to the first clinical trial directly comparing contemporary treatments of radiation, surgery, and active monitoring in patients with prostate cancer. The ProtecT trial was conducted by chief investigator Freddie C. Hamdy, MD, Professor of Surgery, Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom, and colleagues (Hamdy FC, et al. N Engl J Med. 2016 Sep 14. Epub ahead of print). Over a 10-year period, approximately 1% of patients across all 3 interventions died from prostate cancer, and approximately 10% died from any cause. Choice of treatment was found to make a difference in the rate of metastasis and disease progression. Patients randomized to active monitoring experienced a higher rate of metastases and disease progression compared with patients who underwent radiotherapy or surgery. “These differences show the effectiveness of immediate radical therapy over active monitoring, but they have not translated into significant differences—nor have they ruled out equivalence—in disease-specific or all-cause mortality; thus longer-term follow-up is necessary,” said Dr Hamdy and colleagues. In an accompanying editorial, Anthony V. D’Amico, MD, PhD, Chief, Division of Genitourinary Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, commented on the results of the ProtecT trial. “Given no significant difference in death due to prostate cancer with surgery versus radiation and short-course androgen-deprivation therapy, men with low-risk or intermediate-risk prostate cancer should feel free to select a treatment approach using the data on health-related quality of life and without fear of possibly selecting a less effective cancer therapy,” Dr D’Amico said. Dr D’Amico also noted that the incidence of metastatic disease was more than twice as high in the active-monitoring group compared with the other 2 treatment cohorts, stating, “If a man wishes to avoid metastatic prostate cancer and the side effects of its treatment, [active] monitoring should be considered only if he has life-shortening coexisting disease such that his life expectancy is less than the 10-year median follow-up of the current study.” In addition, he pointed out that a trend toward improved prostate cancer−specific survival was observed favoring radiation and androgen-deprivation therapy (ADT). If that trend were to become significant with longer follow-up, then radiation plus ADT could be considered a preferred option for otherwise healthy men aged ≥65 years with early-stage prostate cancer.