Conservative management with symptomatic treatment and delayed hormonal manipulation is justified in men with locally advanced carninoma of the prostate
| Autor: | A. Rana, Geoffrey D. Chisholm, H. M. Rashwan, M. Khan, R. A. Elton |
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| Rok vydání: | 1994 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Urology Population Bone Neoplasms Disease-Free Survival law.invention Metastasis Prostate cancer Randomized controlled trial Actuarial Analysis Prostate law Internal medicine medicine Humans Prospective Studies education Aged Proportional Hazards Models Aged 80 and over Prostatectomy education.field_of_study Proportional hazards model business.industry Prostatic Neoplasms Cancer Middle Aged Prognosis medicine.disease Surgery medicine.anatomical_structure Prostatic acid phosphatase Disease Progression business Orchiectomy Follow-Up Studies |
| Zdroj: | British Journal of Urology. 74:637-641 |
| ISSN: | 1464-410X 0007-1331 |
| DOI: | 10.1111/j.1464-410x.1994.tb09197.x |
| Popis: | Objective To examine the clinical course following surveillance and symptomatic treatment, and compare the outcomes of immediate and delayed hormonal treatment in men with locally advanced prostatic cancer. Patients and methods Of a consecutive series of 199 men (mean age 74 years) with T2-T4 Nx MO prostatic cancer, 110 (55%) were followed until death and the rest had a mean follow-up of 4.2 years. Fifty-one men received immediate orchidectomy, 88 had this treatment delayed until metastatic progression, and 60 had the treatment in the intervening period. The actuarial survival was compared with the expected survival for an age-matched healthy population in Scotland. The adjusted effect of the timing for hormonal manipulation was assessed by including it with age, Gleason score and clinical stage in a multiple Cox regression. Results The actuarial survival for the whole group was 17% less at 5 years and 15% less at 10 years when compared with the expected survival for an age-matched population in Scotland. This was despite the fact that their nodal status was unknown and also those with occult metastasis (elevated serum prostatic acid phosphatase, M1a) at presentation were not excluded. In terms of metastatic progression, overall survival and cause-specific survival, there was no significant difference between immediate and delayed hormonal treatment. Conclusion A conservative approach with surveillance and symptomatic treatment for locally advanced prostatic cancer is justified by the present evidence on disease progression and survival, which do not differ from alternative methods of treatment as reported in contemporary literature. This study has the limitations relative to the ideal of a prospective randomized trial on immediate versus delayed hormonal treatment, but the lack of significant differences in outcome even after adjustment for other established prognostic factors does suggest that there may be little to be gained from an immediate orchidectomy. |
| Databáze: | OpenAIRE |
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