[Active surveillance of prostate cancer: treatement-free survival according to restricted or expanded eligibility criteria]

A Goujon; G Legrand; J Verine; C Hennequin; P Meria; P Mongiat Artus; F Desgrandchamps; A Masson-Lecomte

doi:10.1016/j.purol.2020.04.005

[Active surveillance of prostate cancer: treatement-free survival according to restricted or expanded eligibility criteria]

Prog Urol. 2020 Oct;30(12):646-654. doi: 10.1016/j.purol.2020.04.005. Epub 2020 Sep 12.

[Article in French]

Authors

A Goujon¹, G Legrand², J Verine³, C Hennequin⁴, P Meria⁵, P Mongiat Artus⁶, F Desgrandchamps⁶, A Masson-Lecomte⁶

Affiliations

¹ Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France. Electronic address: Annabelle.goujon@aphp.fr.
² Clinique des Jockeys, Chantilly, France.
³ Université Paris-Diderot, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France.
⁴ Université Paris-Diderot, Paris, France; Service de radiothérapie, hôpital Saint-Louis, AP-HP, Paris, France.
⁵ Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
⁶ Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France.

PMID: 32933827
DOI: 10.1016/j.purol.2020.04.005

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.

Keywords: Active surveillance; Biopsie prostatique; Cancer de prostate; IRM prostatique; Prostate MRI; Prostate biopsy; Prostate cancer; Prostatectomie; Radical prostatectomy; Surveillance active.

MeSH terms

Humans
Male
Overtreatment
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms* / surgery
Prostatic Neoplasms* / therapy
Retrospective Studies
Watchful Waiting*

Substances

Prostate-Specific Antigen