Beyer Katharina, Straten Vera, Remmers Sebastiaan, MacLennan Steven, MacLennan Sara, Gandaglia Giorgio, Willemse Peter-Paul M, Herrera Ronald, Omar Muhammad Imran, Russell Beth, Huber Johannes, Kreuz Markus, Asiimwe Alex, Abbott Tom, Briganti Alberto, Van Hemelrijck Mieke, Roobol Monique J
Translational and Oncology Research (TOUR), King's College London, Faculty of Life Sciences and Medicine, London SE19RT, UK.
Department of Urology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands.
J Pers Med. 2022 May 5;12(5):751. doi: 10.3390/jpm12050751.
Treatment choice for localized prostate cancer is complicated, as each treatment option comes with various pros and cons. It is well established that active surveillance (AS), may be ended with a change to curative treatment at the time of disease progression, but it is less clear whether secondary treatment after initial curative treatment is required. As part of the PIONEER project, we quantified the probabilities of treatment change.
A cohort study based on PRIAS and ERSPC-Rotterdam data was conducted. Patients were followed up for 10 years or until the 31st of December 2017. The primary outcome was the incidence of treatment change following initial treatment (i.e., a change to curative treatment following AS or secondary treatment after initial RP/RT).
Over a period of 1 to 5 years after initial treatment, the cumulative incidence of treatment change ranged from 3.8% to 42.8% for AS, from 7.6% to 12.1% for radical prostatectomy (RP) and from no change to 5.3% for radiation therapy (RT). While the possibility of treatment change in AS is known, the numbers within a five-year period were substantial. For RP and RT, the rate of change to secondary treatment was lower, but still non-neglectable, with 5 (10)-year incidences up to 12% (20%) and 5% (16%), respectively.
This is one of the first studies comparing the incidence of guideline-recommended treatment changes in men receiving different primary treatments (i.e., AS, RT, or RP) for localized prostate cancer (PCa).
局限性前列腺癌的治疗选择较为复杂，因为每种治疗方案都有不同的优缺点。众所周知，主动监测（AS）在疾病进展时可能会转变为根治性治疗，但初始根治性治疗后是否需要二次治疗尚不清楚。作为先锋项目的一部分，我们对治疗转变的概率进行了量化。
开展了一项基于PRIAS和ERSPC - 鹿特丹数据的队列研究。对患者进行了10年的随访，或直至2017年12月31日。主要结局是初始治疗后治疗转变的发生率（即主动监测后转变为根治性治疗，或初始根治性前列腺切除术/放疗后进行二次治疗）。
在初始治疗后的1至五年期间，主动监测的治疗转变累积发生率为3.8%至42.8%，根治性前列腺切除术（RP）为7.6%至12.1%，放射治疗（RT）从无变化至5.3%。虽然主动监测中治疗转变的可能性是已知的，但五年内的数量相当可观。对于RP和RT，二次治疗的转变率较低，但仍不可忽视，5（10）年发生率分别高达12%（20%）和5%（16%）。
这是首批比较接受不同初始治疗（即主动监测、放疗或RP）的局限性前列腺癌（PCa）男性患者中指南推荐治疗转变发生率的研究之一。
