The authors of the recent Prostate Testing for Cancer and Treatment (ProtecT) trial should be commended for their Herculean effort not only to perform and complete a large randomized trial but also to demonstrate the feasibility of randomizing patients with prostate cancer to various treatment strategies (surgery, radiotherapy, and active monitoring).^1,2 However, it is fascinating that despite the results of prior studies, such as the Prostate Cancer Intervention vs Observation Trial (PIVOT), and now ProtecT, which both demonstrated no difference of immediate radical treatment on prostate cancer–specific or overall survival for predominantly favorable-risk patients, that the conclusions drawn by the accompanying editorial were that “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.”^3(p1483) This is especially interesting given that the use of nerve-sparing radical prostatectomy has been demonstrated in multiple large randomized trials, including ProtecT, to result in approximately 70% of baseline potent men to not be able to achieve erections firm enough for intercourse, and 20% of men having long-term urinary incontinence requiring the use of at least 1 pad per day.¹ Furthermore, the use of radical radiotherapy and androgen deprivation therapy demonstrated that approximately 50% of baseline potent men lost the ability to have functional erections 2 years after treatment, and experienced an increased incidence of rectal bleeding.

应该赞扬最近的前列腺癌和治疗试验（ProtecT）试验的作者，他们不仅进行和完成了一项大型随机试验，而且还证明了将前列腺癌患者随机分配到各种治疗策略（手术）的可行性，因此值得赞扬。 ，放疗和主动监测）。^{1 ，2}然而，令人着迷的是，尽管有先前研究的结果，例如前列腺癌干预vs观察试验（PIVOT），现在是ProtecT，两者都显示出对前列腺癌特异性或总体生存率的显着优势，即刻进行根本性根治性治疗并无差异。高危患者，所附社论得出的结论是：“如果一个人希望避免转移性前列腺癌及其治疗的副作用，则只有在他患有缩短寿命的并存疾病时才应考虑[主动]监测。” ^{3 （p1483）}鉴于在许多大型随机试验（包括ProtecT）中已证明保留神经的根治性前列腺切除术的使用会导致大约70％的基线有力男性无法进行足够牢固的勃起以进行性交，这特别有趣，因为20患有长期尿失禁的男性，每天需要使用至少1个护垫的百分比。¹此外，根治性放疗和雄激素剥夺疗法的使用表明，治疗后2年，约有50％的基线有效男性丧失了进行功能性勃起的能力，并且直肠出血的发生率增加。