Active monitoring, surgery, and radiotherapy for cribriform-positive and cribriform negative prostate cancer: secondary analysis of the PROTECT trial

The multinational phase 3 PROTECT trial randomized men with clinically localized prostate cancer to active monitoring, surgery, or radiotherapy with neoadjuvant androgen deprivation therapy (ADT). Secondary retrospective analysis of 15-year outcomes of PROTECT found that the cumulative incidence of metastasis was 25%, 26%, and 8% for men with cribriform-positive disease assigned to active monitoring, surgery, and radiotherapy with neoadjuvant ADT, respectively. For men with cribriform-negative disease, metastasis occurred in 7%, 4%, and 3% in each group, respectively. The authors conclude that patients with cribriform-negative prostate cancer are at low risk of long-term metastasis regardless of baseline treatment, whereas patients with cribriform-positive disease are at high risk of metastasis that is potentially reduced with radiotherapy with neoadjuvant ADT.