Results of Conservative Management of Clinically Localized Prostate Cancer

In France, as in other European countries, management of prostate cancer in the population is rather variable. The objective was to analyse diagnosis and treatment modalities of prostate cancer in patients from French cancer registries.A sample of 803 patients with prostate cancer diagnosed in 1995 was drawn at random from cases recorded in four cancer registries in the geographical regions of Bas-Rhin, Calvados, Isère and Tarn. Diagnosis, clinical staging and treatment were analysed by questionnaire. Multivariate analysis by logistic regression was used to describe medical determinants (age, PSA, clinical staging) of the various treatment choices.The mean age of the patients was 71.6 y (range 46 -94 y). Clinical staging showed 60% T 1 -2 tumours, 15% T 3 -4 and 17% N þ or metastases. PSA rate (median 18.2 ng/ml) was assessed in 92.4% of patients. Prostate cancer was diagnosed by prostate biopsy in 63% and by transurethral resection of the prostate (TURP) in 32% of patients. The main treatments were radical prostatectomy 22%, radiotherapy 19.4%, hormonal therapy 33%, TURP alone 17.7% and expectant management 6%. The method of treatment was unknown in 5.7% of cases. Adjuvant radiotherapy or hormonal therapy had been used in 31% of cases. Logistic regression analysis showed that radical prostatectomy was most often performed in patients aged <60 y, three times more frequently for T 2 tumour and for PSA between 4 and 20 ng/ml. Radiotherapy was the most frequently applied treatment for patients aged between 65 and 75 y, especially in T 3 tumours.Approximately 75% of the patients in the study underwent a specific treatment for prostate cancer with a curative intention in 40%. This study provides a baseline to clinicians and public health authorities on the management of prostate cancer in France with recent data. This survey will be useful to compare future descriptive analysis and to provide data regarding changing clinical practice. Prostate Cancer and Prostatic Diseases (2001) 4, 154-160.

Section: Discussionmentioning

confidence: 97%

A population-based study on management of prostate cancer in four regions of France

Soulié

Grosclaude

Villers

et al. 2001

“…[1][2][3] For example, Albertsen et al reported the long-term outcome of watchful waiting for 767 men diagnosed with clinically localised prostate cancer between 1971 and 1984, aged from 55 to 74 y, who were identified from the Connecticut Tumor Registry. The 15-year prostate cancer mortality for men with Gleason 6 disease was 18-30%, while their 15-y risk of death from other causes was 25-59%.…”

Section: The Natural History Of Early Prostate Cancermentioning

confidence: 99%

Active surveillance of early prostate cancer: rationale, initial results and future developments

Parker

2004

Active surveillance is a new strategy that aims to individualise therapy by selecting only those men with significant cancers for curative therapy based on early evidence of disease progression. Active surveillance must be distinguished from watchful waiting, which for decades has described a policy of observation with the use of palliative treatment for symptomatic progression. The rationale for active surveillance is discussed, based on our knowledge of the natural history of PSA-detected early prostate cancer. The initial results of active surveillance have demonstrated its feasibility. Ongoing studies seek to optimise the active surveillance protocol, and to determine the long-term outcomes. Looking ahead, dietary intervention in men on active surveillance could become an important new paradigm for prostate cancer management.

“…18 These six series originate from four different countries, Sweden, Israel, United Kingdom and the United States. Altogether, data from 828 patients were available and 820 patients were evaluable both with respect to tumor grade and tumor stage.…”

Section: Pooled Analysis Of Series On Deferred Treatmentmentioning

confidence: 99%

“…One example of this is the aforementioned pooled analysis where patients from four different countries were included. 18 Today it is more or less accepted, even by the most aggressive surgeons, that patients with lowgrade low-stage prostate cancer with a life expectancy of 10±15 y or less may not bene®t from aggressive treatment but could be offered deferred treatment as an alternative. 30 This acceptance of deferred treatment is based on the understanding that in most studies the disease-speci®c survival is between 85 and 90% at 10 y after the diagnosis and this does not seem to differ greatly from other treatments up to that point of time.…”

Section: Commentsmentioning

confidence: 99%

Conservative management of clinically localized prostate cancer

Adolfsson

1997

The purpose of this paper is to review and summarize the current knowledge on conservative management of localized prostate cancer. Deferring treatment for low-grade, clinically localized prostate cancer is an acceptable treatment option for patients with a life expectancy of 10±15 y or less. The outcome of available studies on deferred treatment in selected series cannot be compared with the outcome in register studies where the patients have been managed with noncurative intent, nor can it be directly compared with the outcome of selected series on other treatments. The outcome of different treatments for localized prostate cancer can only be compared in randomized studies.