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Goujon A, Legrand G, Verine J, Hennequin C, Meria P, Mongiat Artus P, Desgrandchamps F, Masson-Lecomte A. [Active surveillance of prostate cancer: treatement-free survival according to restricted or expanded eligibility criteria]. Prog Urol 2020; 30:646-654. [PMID: 32933827 DOI: 10.1016/j.purol.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- A Goujon
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - G Legrand
- Clinique des Jockeys, Chantilly, France
| | - J Verine
- Université Paris-Diderot, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - C Hennequin
- Université Paris-Diderot, Paris, France; Service de radiothérapie, hôpital Saint-Louis, AP-HP, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - P Mongiat Artus
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France
| | - F Desgrandchamps
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France
| | - A Masson-Lecomte
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France
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Correlations of post-implant regional dosimetric parameters at 24 hours and one month, with clinical results of low-dose-rate brachytherapy for localized prostate cancer. J Contemp Brachytherapy 2018; 9:499-507. [PMID: 29441093 PMCID: PMC5807997 DOI: 10.5114/jcb.2017.72547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/08/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the correlations of post-implant regional dosimetrics at 24 hours (24 h) and 1 month after implant procedures, with clinical outcomes of low-dose-rate (LDR) brachytherapy for localized prostate cancer. Material and methods Between January 2008 and December 2014, 130 consecutive patients treated for localized prostate cancer, receiving definitive iodine-125 (125I) brachytherapy treatment were retrospectively analyzed. All patients underwent post-implant CT imaging for dosimetric analysis at 24 h and 1 month after implantation procedure. Prostate contours were divided into quadrants: anterior-superior (ASQ), posterior-superior (PSQ), anterior-inferior (AIQ), and posterior-inferior (PIQ). Predictive factors and cut-off values of biochemical failure-free survival (BFFS) and toxicities of LDR brachytherapy were analyzed. Results The median follow-up time was 69.5 months. Seven patients (5.4%) had biochemical failure. The 3-year and 5-year BFFS rates were 96.7% and 93.1%, respectively. On multivariate analysis, prostate-specific antigen and Gleason score were significant prognostic factors for biochemical failure. D90 (the minimal dose received by 90% of the volume) of PSQ and PIQ at 24 h, and D90 of PSQ at 1 month were also significant factors. The cut-off values of PSQ D90 were 145 Gy at 24 h and 160 Gy at 1 month. D90 of the whole prostate was not significant at 24 h and at 1 month. D90 of PSQ at 1 month was a significant factor for rectal hemorrhage. Conclusions Post-implant D90 of PSQ is significantly associated with BFFS for localized prostate cancer not only at 1 month, but also at 24 hours. D90 of PSQ at 1 month is also a significant factor for rectal hemorrhage.
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