Prostate Cancer Study Reveals New Insights into Optimal Treatment Strategies

Strategic Insights -

A recent study published in JAMA Oncology has shed new light on the optimal treatment strategies for patients with prostate cancer, particularly those with cribriform-positive disease. The study, which analyzed data from the PROTECT randomized clinical trial, found that cribriform-positive disease was associated with a significantly increased risk of metastasis, and that radiotherapy with neoadjuvant androgen deprivation therapy (ADT) reduced this risk.

Key Takeaways:

  • The study found that cribriform-positive disease was associated with a 3.61-fold increased risk of metastasis (95% CI, 1.60-8.11) compared to cribriform-negative disease.
  • Radiotherapy with neoadjuvant ADT significantly reduced the risk of metastasis, with a hazard ratio of 0.35 (95% CI, 0.16-0.78) compared to active monitoring.
  • Surgery delayed metastasis but did not significantly improve long-term outcomes compared to active monitoring.
  • Among patients with cribriform-negative disease, incidence of metastasis was low and did not differ by treatment.
  • The study's findings suggest that cribriform morphology is a strong, independent predictor of long-term metastasis risk in patients with prostate cancer.
  • The results of the study support the use of active surveillance for patients with cribriform-negative disease.
  • The study was conducted at Cambridge University Hospitals NHS Foundation Trust and was supported by the National Institute for Health Research (NIHR).

Statistics:

  • 712 men were included in the retrospective review of their biopsies, of which 93 (13.1%) had cribriform-positive disease.
  • 42 (5.9%) of the men with cribriform-positive disease developed metastasis.
  • The 15-year cumulative incidence of metastasis in patients with cribriform-positive disease was 8% with radiotherapy and neoadjuvant ADT, 26% with surgery, and 25% with active monitoring.
  • The study included 1643 men with clinically localized prostate cancer who were randomly assigned to receive active monitoring, surgery, or radiotherapy with neoadjuvant ADT.
  • The study was conducted between 1999 and 2009.

Sources:

  • NewsRx. Data from Cambridge University Hospitals NHS Foundation Trust Provide New Insights into Prostate Cancer (Active Monitoring, Surgery, and Radiotherapy for Cribriform-Positive and Cribriform-Negative Prostate Cancer: A Secondary Analysis of the ...). Cancer Weekly. October 28, 2025; p 152.
  • Active Monitoring, Surgery, and Radiotherapy for Cribriform-Positive and Cribriform-Negative Prostate Cancer: A Secondary Analysis of the PROTECT Randomized Clinical Trial. JAMA Oncology, 2025.