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ObjectivesActive surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men’s strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care.DesignLongitudinal serial in-depth qualitative interviews every 2–3 years for a median 7 (range 6–14) years following diagnosis.SettingFour centres within the UK Protect trial.ParticipantsPurposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52–68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8–13.8 years).InterventionAM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6–12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review.Main outcomesThematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care.ResultsMen sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences.ConclusionMen looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term.Trial registration numberISRCTN20141297; Pre-results.

Background Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. Objectives To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50–69 years. Design A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Setting Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Participants Between 2001 and 2009, 228,966 men aged 50–69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. Interventions The interventions were active monitoring, radical prostatectomy and radical radiotherapy. Trial primary outcome measure Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. Secondary outcome measures Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. Results There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p Limitations A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. Conclusions At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. Trial registration Current Controlled Trials ISRCTN20141297. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information.

Objectives:Recruitment to pragmatic trials is often difficult, and little is known about factors associated with key participation and treatment decisions. These were explored in the Prostate cancer testing and Treatment (ProtecT) study. Study Design and Setting:Baseline sociodemographic, patient-reported outcome, clinical history, and prostate cancer biopsy data were collected for all patients eligible to take part in the ProtecT trial, in a comprehensive cohort design. Men who rejected randomization specified a preferred option and were followed up identically to the randomized cohort. Factors associated with participation decisions, patient preferences, and reasons for changing treatment were explored. Results:Of 2,664 men with clinically localized prostate cancer, 997 (37%) rejected randomization. Their treatment preferences and subsequent treatment choices/changes in both randomized and treatment choice cohorts were strongly associated with prostate cancer risk features: toward active monitoring for low-risk disease and toward radical options with higher risk prostate cancer. Among many factors measured, only a small number of weak associations were found for occupation groups and some patient symptoms. Similar percentages changed from the random allocation and initially stated preference. Conclusion:The comprehensive cohort design provided new insights into trial recruitment and participation decisions. Opportunities to improve recruitment by supporting recruiters with equipoise and patient preferences were identified.

Objectives\ud \ud Randomized controlled trials (RCTs) deliver robust internally valid evidence but generalizability is often neglected. Design features built into the Prostate testing for cancer and Treatment (ProtecT) RCT of treatments for localized prostate cancer (PCa) provided insights into its generalizability.\ud \ud \ud Study Design and Setting\ud \ud Population-based cluster randomization created a prospective study of prostate-specific antigen (PSA) testing and a comprehensive-cohort study including groups choosing treatment or excluded from the RCT, as well as those randomized. Baseline information assessed selection and response during RCT conduct.\ud \ud \ud Results\ud \ud The prospective study (82,430 PSA-tested men) represented healthy men likely to respond to a screening invitation. The extended comprehensive cohort comprised 1,643 randomized, 997 choosing treatment, and 557 excluded with advanced cancer/comorbidities. Men choosing treatment were very similar to randomized men except for having more professional/managerial occupations. Excluded men were similar to the randomized socio-demographically but different clinically, representing less healthy men with more advanced PCa.\ud \ud \ud Conclusion\ud The design features of the ProtecT RCT provided data to assess the representativeness of the prospective cohort and generalizability of the findings of the RCT. Greater attention to collecting data at the design stage of pragmatic trials would better support later judgments by clinicians/policy-makers about the generalizability of RCT findings in clinical practice.

Aims: The treatment of prostate cancer has evolved markedly over the last 40 years, including radiotherapy, notably with escalated dose and targeting. However, the optimal treatment for localised disease has not been established in comparative randomised trials. The aim of this article is to describe the history ofprostate radiotherapy trials, including their quality assurance processes, and to compare these with the ProtecT trial.Materials and methods: The UK ProtecT randomised trial compares external beam conformal radiotherapy, surgery and active monitoring for clinically localized prostate cancer and will report on the primary outcome (disease-specific mortality) in 2016 following recruitment between 1999 and 2009. The embedded quality assurance programme consists of on-site machine dosimetry at the nine trial centres, a retrospective review of outlining and adherence to dose constraints based on the trial protocol in 54 participants (randomly selected, around 10% of the total randomised to radiotherapy, n ¼ 545). These quality assurance processes and results were compared with prostate radiotherapy trials of a comparable era.Results: There has been an increasingly sophisticated quality assurance programme in UK prostate radiotherapy trials over the last 15 years, reflecting dose escalation and treatment complexity. In ProtecT, machine dosimetry results were comparable between trial centres and with the UK RT01 trial. The outliningreview showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of theprostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints inProtecT was considered acceptable, with 80% of randomised participants having two or less deviations and planning target volume coverage was excellent.Conclusion: The ProtecT trial quality assurance results were satisfactory and comparable with trials of its era. Future trials should aim to standardise treatment protocols and quality assurance programmes where possible to reduce complexities for centres involved in multiple trials. 2016 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer–specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practices across the United Kingdom. Randomization and recruitment of the practices occurred between 2001 and 2009; patient follow-up ended on March 31, 2016. Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs standard (unscreened) practice. Main Outcomes and Measures Primary outcome: prostate cancer–specific mortality at a median follow-up of 10 years. Prespecified secondary outcomes: diagnostic cancer stage and Gleason grade (range, 2-10; higher scores indicate a poorer prognosis) of prostate cancers identified, all-cause mortality, and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic. Results Among 415 357 randomized men (mean [SD] age, 59.0 [5.6] years), 189 386 in the intervention group and 219 439 in the control group were included in the analysis (n = 408 825; 98%). In the intervention group, 75 707 (40%) attended the PSA testing clinic and 67 313 (36%) underwent PSA testing. Of 64 436 with a valid PSA test result, 6857 (11%) had a PSA level between 3 ng/mL and 19.9 ng/mL, of whom 5850 (85%) had a prostate biopsy. After a median follow-up of 10 years, 549 (0.30 per 1000 person-years) died of prostate cancer in the intervention group vs 647 (0.31 per 1000 person-years) in the control group (rate difference, −0.013 per 1000 person-years [95% CI, −0.047 to 0.022]; rate ratio [RR], 0.96 [95% CI, 0.85 to 1.08]; P = .50). The number diagnosed with prostate cancer was higher in the intervention group (n = 8054; 4.3%) than in the control group (n = 7853; 3.6%) (RR, 1.19 [95% CI, 1.14 to 1.25]; P

Objectives: The objective of this study was to describe and evaluate a training intervention for recruiting patients to randomized controlled trials (RCTs), particularly for those anticipated to be difficult for recruitment. Study Design and Setting: One of three training workshops was offered to surgeons and one to research nurses. Self-confidence in recruitment was measured through questionnaires before and up to 3 months after training; perceived impact of training on practice was assessed after. Data were analyzed using two-sample t-tests and supplemented with findings from the content analysis of free-text comments. Results: Sixty-seven surgeons and 32 nurses attended. Self-confidence scores for all 10 questions increased after training [range of mean scores before 5.1–6.9 and after 6.9–8.2 (scale 0–10, all 95% confidence intervals are above 0 and all P-values

In complex high-investment assets, project owners are primarily focused on engineering and geological uncertainties. Non-technical risks (NTRs), misunderstood or mispriced, pose huge impediments to the success in the current energy landscape, on average accounting for 75% performance failures. This paper presents a new integrated approach applied to the capital Project X situated near the Caspian Sea. The case study explores contingency recommendations, heat maps and correlation matrices to integrate NTRs into ongoing venture management. The proposed methodology is summarized in the following key milestones. 1st Process walkthroughs to obtain snapshot of internal system and identify key areas of NTRs. 2nd Value and interaction maps for visual alignment of identified challenges and the first level insight of potential interfaces. 3rd Development of a macro picture for NTRs integration using risk wheel, heat map, and bow-tie diagram; identification of optimal risk-taking zone and value impact simulation using Monte Carlo approach. 4th A trial assessment and prioritization of NTRs, according to their criticality to the project and potential manageability. The suggested approach was applied in Project X to amplify the universe of risks that is making up the current risk profile. Risk interactions were mapped in a correlation matrix; NTRs with complex risk nature were broken down into components to identify the root cause of events leading to its occurrence. Using qualitative criteria and speed of onset, risk interactions were evaluated for the highest risks and plotted in a heat map for a further prioritization. Based on simulation of impact, 55% of listed "key" risks are NTRs which confirmed the practical applicability of the suggested method. Full scale implementation of the proposed approach reduced bias towards operational threats across the project spectrum, increased awareness of teams towards potential risk sources, implemented more stringent levers of venture control resulting in better informed and confident investment decisions at the Consortium level. The novelty of presented work is a coherent approach that is still new for the petroleum industry. While not intended to replace already existing risk strategies, it challenges the technical mindset traditionally adopted in capital projects. The proposed method allows project teams, whether novices or experts, to react more proactively towards NTRs, building a solid foundation for the dynamic process that recognize the diverse nature of risk in the modern petroleum business.

Background The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. Methods We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. Results There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P

Objectives: To develop a nurse-led, urologist-supported model of care for men managed by active surveillance or active monitoring (AS/AM) for localised prostate cancer and provide a formative evaluation of its acceptability to patients, clinicians and nurses. Nurse-led care, comprising an explicit nurse-led protocol with support from urologists, was developed as part of the AM arm of the Prostate testing for cancer and Treatment (ProtecT) trial.Design: Interviews and questionnaire surveys of clinicians, nurses and patients assessed acceptability.Setting: Nurse-led clinics were established in 9 centres in the ProtecT trial and compared with 3 non-ProtecT urology centres elsewhere in UK.Participants: Within ProtecT, 22 men receiving AM nurse-led care were interviewed about experiences of care; 11 urologists and 23 research nurses delivering ProtecT trial care completed a questionnaire about its acceptability; 20 men managed in urology clinics elsewhere in the UK were interviewed about models of AS/AM care; 12 urologists and three specialist nurses working in these clinics were also interviewed about management of AS/AM.Results: Nurse-led care was commended by ProtecT trial participants, who valued the flexibility, accessibility and continuity of the service and felt confident about the quality of care. ProtecT consultant urologists and nurses also rated it highly, identifying continuity of care and resource savings as key attributes. Clinicians and patients outside the ProtecT trial believed that nurse-led care could relieve pressure on urology clinics without compromising patient care.Conclusions: The ProtecT AM nurse-led model of care was acceptable to men with localised prostate cancer and clinical specialists in urology. The protocol is available for implementation; we aim to evaluate its impact on routine clinical practice.

Zeffirelli was asked to direct Romeo and Juliet largely as a result of his recent work at Covent Garden. The management of the Old Vic was attracted as much by his talents as a designer of atmospheric Italian settings for Cavalleria Rusticana as by his skills as a director. Zeffirelli set about stripping away the accretions of outdated romantic conventions of acting and staging in an attempt to bring the play to life for a modern, primarily young, audience. His aim was to achieve a feeling of naturalism, essentially by providing appropriate visual expression to Shakespeare’s text.

‘These violent delights have violent ends’ was printed in bold type across the centre page of the programme and seemed to have been Terry Hands’ central text in planning this production. Almost every detail contributed to its robust energy, from the opening street scene, with a naked flame burning high on an upstage wall creating a sense of foreboding before an opening explosion of exhilarating violence, to the enthusiasm with which Juliet passed the time while waiting for the Nurse’s return with a message from Romeo by beating the carpets hung from clotheslines cluttering the stage. This was a production in which it was abundantly clear that the director intended to dispel any illusions of joyful romance. Several key directorial and design decisions dominated the production and clearly influenced the actors.

The close affinity between much of the poetry of Romeo and Juliet and the highly wrought artifice of the Petrarchan sonnet can best be illustrated by a brief extract: Here’s much to do with hate, but more with love. Why then, O brawling love, O loving hate, O anything of nothing first create! O heavy lightness, serious vanity, Misshapen chaos of well-seeming forms! Feather of lead, bright smoke, cold fire, sick health Still-waking sleep that is not what it is! (I i 175–81)

The division of any of Shakespeare’s plays into acts and scenes often misleads readers into neglecting the seamless flow and pacing that are possible on a stage uncluttered by excessive scenery. In this particular instance we must bear in mind that on the sort of stage that is commonly conjectured for Elizabethan productions of the play Juliet’s mock death at the end of Act IV would have led in an unbroken sequence to the events of Act V. On a functional level the comic exchanges by the musicians that end Act IV would have occupied the foreground, while Juliet’s bed was hidden behind a curtain in the upstage alcove that was probably part of the standard Elizabethan stage design. Romeo’s entrance at the beginning of the next act would then have taken place directly in front of the curtained alcove that contained Juliet’s drugged body; the same space would be in turn transformed into the tomb for the final scene. Given appropriate staging the text therefore is richly ironic, as it fuses the tragi-comic grief over Juliet’s ‘dead’ body with the increasingly tragic claustrophobia of the final scenes. Capulet’s description perfectly captures the confusion of moods: All things that we ordained festival Turn from their office to black funeral: Our instruments to melancholy bells, Our wedding cheer to a sad burial feast; Our solemn hymns to sullen dirges change, Our bridal flowers serve for a buried corse; And all things change them to the contrary. (IV v 84–90)

It is clear, therefore, that Shakespeare achieves a kind of harmony through variety in the play’s language and imagery. The technique used is essentially comic, with many parallels to be found in the comedies of the same period. For example, Love’s Labour’s Lost also brings together a lavish variety of distinctive languages, from the courtly sonneteering of the Lords — which is not unlike Romeo’s early style — to the blank incomprehension of Constable Dull. All are combined in a ‘great feast of languages’ that at the end of the play almost achieves the harmony of a comic resolution, only to be deferred by the intrusion of death. In A Midsummer Night’s Dream Hippolyta provides the most familiar and succinct summary of the technique, by describing the various cries of Theseus’s hunting hounds as ‘musical discord … sweet thunder’. However, such a technique is by no means the only one by which Shakespeare seeks to control the audience’s responses to the story of the two lovers. As T. J. B. Spencer describes it in his introduction to the New Penguin edition of the play (1967): ‘we observe the progressive isolation both of Juliet and of Romeo in their environments. Their love gradually separates them from their friends and families’. (p. 28)

The design by Chris Dyer for Michael Bogdanov’s production signalled one of the most striking and challenging attempts to lend the play an overt modernity. Apparently constructed of white marble and chrome, the set was all harsh angles and sharp edges, with a central area of open staircases and landings. This revolving centre piece was backed by constantly changing photographic blow-ups of modern society figures and fragments of modern architecture. The set even incorporated a swimming pool. Every detail was aggressively modern, from policemen on motorcycles wearing sunglasses, to a buzzing intercom for Capulet’s marble desk and to the fashionable Italian-design modern clothing worn by the cast. The fight scene between Mercutio and Tybalt contained the most striking example of the often flippant nature of this drive to establish the play’s modernity. This duel began as a display of machismo and bluff and was only precipitated into genuine anger once Mercutio scratched Tybalt’s sports car — inevitably, a gleaming Alfa Romeo.

The history of Romeo and Juliet, both in performance and as a text for critical scrutiny, has inevitably been dominated by the eponymous heroes. However, this has almost certainly had some serious consequences which may well have distorted our perception of the play. To some extent the difficulties faced by modern audiences may be attributed to the inevitable changes in theatrical taste which affect any of Shakespeare’s plays. For example, in his New Penguin edition of the play, T. J. B. Spencer suggests two such serious consequences: first, our difficulty in understanding some of Mercutio’s complex puns tends to ‘soften’ his impact in modern performance; moreover, the Friar’s moralizing is ‘rendered weaker than Shakespeare’s text authorizes’ (p. 8). In fact it is probably true that much of what has often been taken as simply the background to the lovers has been undervalued, so that we are tempted to concentrate our attention upon questions centred upon the lovers’ rashness while ignoring the importance of the self-perpetuation of violence as well as the lovers’ role in its final exorcism. Simon Trussler reminds us that the modern tendency to read the play through the filter of a pre-determined definition of tragedy which focuses exclusively upon the lovers’ flaws can result in disastrous interpretations: What a grievous symptom of the working assumptions of our society that the one character in the play who achieves, for all its brevity, a happy and mutually fulfilled sexual relationship, the one character [Romeo] who, however disastrous the consequences, actually tries to step between violent antagonists, should be regarded as immoderate! (Programme/Playtext to 1988 RSC production)

In 1976 the management of the Royal Shakespeare Company took a deliberate artistic decision to use a single fixed set, designed by John Napier and Chris Dyer, that did as much as possible to transform Stratford’s large, essentially prosceniumarch auditorium into something approximating to an Elizabethan stage. In fact the management denied that they had any thoughts of the seventeenth-century stage in mind, claiming instead that they had simply sought to create a simple, fluid acting space. In the end this amounted to much the same thing, as most audiences were aware. The front of the stage was built out into the auditorium to give something of the effect of a thrust stage and two wooden-framed tiers, containing bench seats for spectators, were constructed to encircle the back of the stage. The result was a nearly circular acting area, with the audience virtually all round the stage. The balcony for Romeo and Juliet was simply an extension that blended into the centre of the tiers. Nothing cluttered the bare stage aside from a few movable props such as beds and stools. Costumes were loosely Jacobean, with the exception of the Chorus, who was dressed incongruously in modern casual attire. Few lighting effects were attempted. Instead a range of spotlights, which filled the area over the stage, was as a rule simply used to flood the stage with light: the interior equivalent of afternoon sun.

Background Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes. Methods We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle. Results The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life. Conclusions In this analysis of patient-reported outcomes after treatment for localized prostate cancer, patterns of severity, recovery, and decline in urinary, bowel, and sexual function and associated quality of life differed among the three groups.(Funded by the U.K. National Institute for Health Research Health Technology Assessment Program; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172).