Active surveillance of prostate cancer : treatement-free survival according to restricted or expanded eligibility criteria
Copyright © 2020 Elsevier Masson SAS. All rights reserved..
AIM: Overtreatment is an actual problem in low risk localized prostate cancer (PC) management. Active surveillance (AS) is a solution to limit this problem, but eligibility criteria remained discussed. The aim was to assess possibilities of widening selection criteria for patient in AS, studying curative treatment free survival (CTFS) according to restricted or expanded eligibility criteria.
METHODS: We retrospectively studied patients beginning AS between 2008 and 2014, for Gleason 6 localized PC, PSA<15ng/ml,<cT3. The group "strict criteria" was defined:≤cT2a, PSA<10ng/ml, 2≤positive biopsies (PB+), total tumoral length≤3mm, tumoral invading≤50%, PSA density≤0,15ng/ml/cm3. MRI was performed at baseline and during follow-up. Radical treatment was proposed in case of biological, histological or clinical progression. Criteria associated with AS survival were analyzed by Cox regression.
RESULTS: One hundred eighty patients were included (follow-up 46 months). One hundred and eleven patients had "strict" criteria vs. 69 "expanded" criteria. Eighty-two patients (45%) were treated with median time of 18.2 months (CTFS was 71% at 2 years, 52% at 5 years.). The widening of the inclusion criteria was not associated with CTFS (65 vs 54% at 5 years, P=0.13). Factors significatively associated with discontinuation of AS were bilaterality (HR=2.12) and abnormal rectal digital examination cT2 (HR=2,07); MRI target (HR=2,48)) tended towards significance.
CONCLUSION: Our study concludes that curative treatment free survival is similar for patients included with expanded criteria compared with those included with strict criteria. However, high initial cancer volume) is associated with AS discontinuation.
LEVEL OF EVIDENCE: 3.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
|---|---|
| Enthalten in: |
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie - 30(2020), 12 vom: 05. Okt., Seite 646-654 |
| Sprache: |
Französisch |
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| Weiterer Titel: |
Surveillance active du cancer de prostate : survie sans traitement curatif selon critères d’éligibilité stricts ou élargis |
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| Beteiligte Personen: |
Goujon, A [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 10.12.2021 Date Revised 14.12.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.purol.2020.04.005 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315057254 |
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| 100 | 1 | |a Goujon, A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Active surveillance of prostate cancer |b treatement-free survival according to restricted or expanded eligibility criteria |
| 246 | 3 | 3 | |a Surveillance active du cancer de prostate : survie sans traitement curatif selon critères d’éligibilité stricts ou élargis |
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| 500 | |a Date Revised 14.12.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a AIM: Overtreatment is an actual problem in low risk localized prostate cancer (PC) management. Active surveillance (AS) is a solution to limit this problem, but eligibility criteria remained discussed. The aim was to assess possibilities of widening selection criteria for patient in AS, studying curative treatment free survival (CTFS) according to restricted or expanded eligibility criteria | ||
| 520 | |a METHODS: We retrospectively studied patients beginning AS between 2008 and 2014, for Gleason 6 localized PC, PSA<15ng/ml,<cT3. The group "strict criteria" was defined:≤cT2a, PSA<10ng/ml, 2≤positive biopsies (PB+), total tumoral length≤3mm, tumoral invading≤50%, PSA density≤0,15ng/ml/cm3. MRI was performed at baseline and during follow-up. Radical treatment was proposed in case of biological, histological or clinical progression. Criteria associated with AS survival were analyzed by Cox regression | ||
| 520 | |a RESULTS: One hundred eighty patients were included (follow-up 46 months). One hundred and eleven patients had "strict" criteria vs. 69 "expanded" criteria. Eighty-two patients (45%) were treated with median time of 18.2 months (CTFS was 71% at 2 years, 52% at 5 years.). The widening of the inclusion criteria was not associated with CTFS (65 vs 54% at 5 years, P=0.13). Factors significatively associated with discontinuation of AS were bilaterality (HR=2.12) and abnormal rectal digital examination cT2 (HR=2,07); MRI target (HR=2,48)) tended towards significance | ||
| 520 | |a CONCLUSION: Our study concludes that curative treatment free survival is similar for patients included with expanded criteria compared with those included with strict criteria. However, high initial cancer volume) is associated with AS discontinuation | ||
| 520 | |a LEVEL OF EVIDENCE: 3 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Active surveillance | |
| 650 | 4 | |a Biopsie prostatique | |
| 650 | 4 | |a Cancer de prostate | |
| 650 | 4 | |a IRM prostatique | |
| 650 | 4 | |a Prostate MRI | |
| 650 | 4 | |a Prostate biopsy | |
| 650 | 4 | |a Prostate cancer | |
| 650 | 4 | |a Prostatectomie | |
| 650 | 4 | |a Radical prostatectomy | |
| 650 | 4 | |a Surveillance active | |
| 650 | 7 | |a Prostate-Specific Antigen |2 NLM | |
| 650 | 7 | |a EC 3.4.21.77 |2 NLM | |
| 700 | 1 | |a Legrand, G |e verfasserin |4 aut | |
| 700 | 1 | |a Verine, J |e verfasserin |4 aut | |
| 700 | 1 | |a Hennequin, C |e verfasserin |4 aut | |
| 700 | 1 | |a Meria, P |e verfasserin |4 aut | |
| 700 | 1 | |a Mongiat Artus, P |e verfasserin |4 aut | |
| 700 | 1 | |a Desgrandchamps, F |e verfasserin |4 aut | |
| 700 | 1 | |a Masson-Lecomte, A |e verfasserin |4 aut | |
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