The treatment of prostate cancer is the central subject of this study recently published in the scientific journal New England Journal of Medicine. This study addresses possible treatment options for localized prostate cancers and their long-term influence on patient survival. It also raises the question of whether it is necessary to systematically treat localized prostate cancers.
Localized prostate cancer, an indication for active surveillance?
Treatment recommendations for prostate cancer indicate the possible use of different treatment options after diagnosis:
- Surgery ;
- Radiotherapy;
- Chemotherapy;
- Targeted therapies, including hormone therapy and immunotherapy.
in case of localized cancer, is treatment routinely required and does it significantly influence long-term survival? Currently, not all prostate cancers are treated immediately. Some patients with localized cancers initially benefit from a surveillance activeincluding every six months a clinical examination, a Rectal touch and one dosage you PSA (Prostatic Specific Antigen). One year after diagnosis, a prostate biopsy is carried out, then every two to three years.
Comparing two treatments to active surveillance
In a large-scale study, conducted between 1999 and 2009 in the United Kingdom, researchers collected the results of PSA tests from 82,429 men, aged 50 to 69. Of these men, 2,664 were diagnosed with a localized prostate cancer and 1,643 of them took part in a trial to compare the effectiveness of different therapeutic strategies:
- 545 had active surveillance;
- 553 underwent prostatectomy ;
- 545 were treated by radiotherapy.
The participants were followed for an average of 15 years (from 11 to 21 years depending on the patient). The criteria taken into account were mortality linked to prostate cancer, mortality from all causes, the existence of metastasesdisease progression and the initiation of a androgen therapy long-term.
Localized prostate cancer, treat after benefit-risk assessment
Of the 1,610 patients who had full follow-up, more than a third had an intermediate-to-high risk tumor at the time of prostate cancer diagnosis. Prostate cancer-related mortality was 2.7%, with small differences between the three groups of patients (3.1% in the “active surveillance”, 2.2% in the “prostatectomy” group and 2. 9% in the “radiotherapy” group. Mortality linked to prostate cancer was not dependent on the initial PSA level, the stage of the tumor, its grade or the risk stratification score. Indeed, mortality all causes was 21.7% on average, with similar figures in the three groups.
The development of metastases was higher in the “active surveillance” group with a rate of 9.4%, against 4.7% in the “prostatectomy” group and 5.0% in the “radiation therapy” group. The same was true for two other parameters:
- Initiation of long-term androgen therapy;
- clinical progression.
At the end of the study, 24.4% of the men in the “active surveillance” group were still alive, without having received any treatment for their prostate cancer. This long-term follow-up study highlights that each therapeutic strategy must be established taking into account the benefits and risks of the treatments undertaken in relation to active monitoring of the tumour.
Estelle B., Doctor of Pharmacy
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