Whole-gland ablation therapy versus active surveillance for low-risk prostate cancer: a prospective study.
active surveillance
brachytherapy
cryoablation
high intensity focused ultrasound
low-risk
prostate cancer
Journal
Central European journal of urology
ISSN: 2080-4806
Titre abrégé: Cent European J Urol
Pays: Poland
ID NLM: 101587101
Informations de publication
Date de publication:
2020
2020
Historique:
received:
21
01
2020
revised:
02
04
2020
accepted:
04
04
2020
entrez:
13
8
2020
pubmed:
13
8
2020
medline:
13
8
2020
Statut:
ppublish
Résumé
The objective of this study is assess the outcomes of whole-gland ablation (high-intensity focused ultrasound (HIFU), cryotherapy and brachytherapy) and active surveillance (AS) in patients with low-risk prostate cancer (PCa). This prospective non-randomised study included 155 patients with low-risk PCa managed with either ablative therapy or AS. Follow-up included mpMRI, biopsies, prostate-specific antigen (PSA), quality of life and complications for up to 24 months. The primary endpoint was cancer progression. The secondary endpoint was the impact of each treatment on the quality of life. Mean total preoperative PSA was 8.8 ±1.5 ng/ml. Of 155 patients, 125 received treatment: 45 - HIFU; 45 - cryoablation; 35 - brachytherapy. Thirty were under AS. Mean nadir PSA levels were 0.64 ±0.55 ng/ml for HIFU, 0.53 ±0.38 ng/ml for cryoablation and 0.48 ±0.34 ng/ml for brachytherapy. In the AS group, mean PSA was 9.9 ±3.8 ng/ml. Biochemical relapse-free survival rates at 24 months were 81.8% for HIFU, 85% for cryoablation, 93.9% for brachytherapy and 93.3% for AS. In only one HIFU patient relapse was not confirmed on biopsy. Increased anxiety was found in up to 6.7% after treatment and in 36.7% of patients undergoing AS. The Kaplan-Meier analysis revealed no statistical differences between the techniques. Whole-gland ablative therapy can be considered a viable treatment modality for carefully selected patients with low-risk PCa who are reluctant to select AS due to anxiety.
Identifiants
pubmed: 32782830
doi: 10.5173/ceju.2020.0009
pii: 0009
pmc: PMC7407774
doi:
Types de publication
Journal Article
Langues
eng
Pagination
127-133Informations de copyright
Copyright by Polish Urological Association.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Lancet. 2014 Dec 6;384(9959):2027-35
pubmed: 25108889
Eur Urol. 2015 Nov;68(5):805-11
pubmed: 25800944
J Urol. 2016 Dec;196(6):1651-1658
pubmed: 27569437
Springerplus. 2016 Nov 3;5(1):1905
pubmed: 27867812
N Engl J Med. 2016 Oct 13;375(15):1415-1424
pubmed: 27626136
Eur Urol. 2019 Feb;75(2):208-214
pubmed: 30274702
Urology. 2007 Dec;70(6 Suppl):42-4
pubmed: 18194711
J Clin Oncol. 2015 Jan 20;33(3):272-7
pubmed: 25512465
J Urol. 2019 Nov;202(5):964-972
pubmed: 31112105
J Urol. 2018 Dec;200(6):1250-1255
pubmed: 29886089
Int J Radiat Oncol Biol Phys. 2017 May 1;98(1):101-107
pubmed: 28586945
Eur Urol. 1997;32(2):129-32
pubmed: 9286641
J Endourol. 2017 Jun;31(6):564-571
pubmed: 28385075
BJU Int. 2013 May;111(5):753-60
pubmed: 23464824
Eur Urol. 2016 Dec;70(6):954-960
pubmed: 27329565
J Clin Oncol. 2013 Nov 20;31(33):4235-41
pubmed: 24145343
Eur Urol. 2003 Sep;44(3):315-20; discussion 320-1
pubmed: 12932929
J Acquir Immune Defic Syndr. 2005 Nov 1;40(3):378-80
pubmed: 16249716
J Urol. 2018 Mar;199(3):683-690
pubmed: 29203269
Urology. 2002 Aug;60(2 Suppl 1):3-11
pubmed: 12206842
J Urol. 2008 Nov;180(5):1993-2004
pubmed: 18817934
Curr Opin Urol. 2015 May;25(3):232-7
pubmed: 25692723
Eur Urol. 2012 Dec;62(6):976-83
pubmed: 22698574
Health Technol Assess. 2015 Jul;19(49):1-490
pubmed: 26140518