Obligatory information that a patient diagnosed of prostate cancer and candidate for an active surveillance protocol must know

Autor: José Rubio-Briones, Miguel A. Ramirez, A. Calatrava, D. Salas, R. Dumont, A. Collado, Álvaro Gómez-Ferrer, J.L. Monrós, Inmaculada Iborra, J.V. Ricós, José Antonio López-Guerrero, Juan Casanova, Eduardo Solsona, J. Domínguez-Escrig
Rok vydání: 2014
Předmět:
Zdroj: Actas Urológicas Españolas (English Edition). 38:559-565
ISSN: 2173-5786
DOI: 10.1016/j.acuroe.2014.09.004
Popis: Objectives To know the necessary information to reproduce the results found in the literature on active surveillance (AS) in prostate cancer (PCa) in our own center so that the information would be objective and correctly given to the patients. We have aimed to study the percentage of candidates for AS chosen in our setting, and the data on infrastaging, subgrading and prediction of insignificant PCa, debugging the predictive value of clinical variables to improve our selection criteria and finally to analyze the results of our patients enrolled in AS. Materials and methods A retro- and prospective review of our databases was performed. A one-year period was analyzed to know AS candidates. Analysis of our radical prostatectomy specimens for infrastaging, subgrading and prediction of insignificant PCa (Epstein's criteria) was made as well as a uni/multivariate analysis of clinical variables in patients with insignificant PCa in the specimen. A prospective validation was performed with overall survival and survival free of active treatment (SFAT) as endpoints in patients enrolled in AS. Results Between October-2010 and October-2011, 44.7% of our PCa were candidates for AS, but only 11.2% chose it. The percentages found for infrastaging, subgrading and prediction of insignificant PCa were 14%, 31.4% and 55.7%, respectively. However, only just 6 patients (6.97%) had ≥pT3a + Gleason ≥7 + volume >0.5 cc PCa. The multivariate analysis showed that PSA density and number of affected cores were independent predictors of insignificant PCa. With a mean follow-up of 36 ± 39 months, 63 out of 232 patients enrolled in AS went on to active treatment (27.1%), with only 13 due to anxiety without pathologic progression. Median time of SFAT was 72.7 months (CI 95% 30.9–114.4). SFAT at 24 months was 76.4% (69.7–83.1%) and at 48 months 58.1% (48.8–67.4%). Only 10 patients died (4.3%), 9 due to causes different of PCa. Estimated overall survival at 5 years was 92.8% (CI 95% 86.7–98.9%). Conclusions It should be mandatory to have the exact knowledge of the local data of each center in order to objectively inform patients about prostate biopsy efficiency, and if percentages of infrastaging, subgrading and prediction of insignificant PCa are in accordance with the literature. At 3 years, we reproduced the results of the longest series of AS, so we have ascertained that our AS protocol can be implemented with increasingly more patients.
Databáze: OpenAIRE
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