Patterns of Daily Practice of Hormone Therapy in Unfavorable and Favorable Intermediate-Risk Prostate Cancer: Results of the French PROACT Survey

Abstract

The management of intermediate-risk (IR) prostate cancer (PCa) remains controversial for a subgroup of patients considered as heterogeneous in terms of prognosis. For unfavorable or favorable-IR PCa optimal therapy approach remains to be defined. Two randomized trials have shown improved biochemical control outcomes using external beam radiation therapy (EBRT) and hormone therapy (HT) over EBRT alone. However, physician’s decision to propose HT is not based on a robust rational for a routine practice. Thus, we decided, as academic and private group, to conduct the PROACT survey on pattern and preferences of daily practice in unfavorable and favorable IR PCa patients. The web-questionnaire was distributed to the GETUG, French radiotherapy and the French Association of Urology members. Responses from individual members were registered between January and December 2016. The questionnaire included 4 sections to describe: (i) specialists who prescribe treatments, decisions validation manner and use of guidelines; (ii) definition of IR subsets of patients; (iii) EBRT parameters and the choice of type/duration/sequence of HT and the prescribed drugs; (iv) cardiovascular (CV) and metabolic initial evaluation and follow-up practice. Among the 82 responses recorded, 79 (96%) were radiation oncologists from private or anti-cancer center (72%). HT and irradiation technique/dose/volumes is validated in a specific board meeting in only 45% and 54% of the centers. For prognosis, 76% of the centers declared to identify a subset of IR-patients for a dedicated strategy. The majority of centers consider PSA>15 (77%) and/or Gleason 4+3 (87%) as the main parameters for unfavorable IR definition. Overall, 41% of the centers declared to perform systematically a CV evaluation before HT prescription while 61% take into account the CV history/status to define the type of HT. In addition, CV status (80%) and age (39%) were declared as the main parameters for a specific drug choice. LHRH agonists are more frequently prescribed in both favorable (70%) and unfavorable (98%) IR. EBRT following hypofractionated schedules is used in only 10% and 14% of the centers and pelvic irradiation in 59% and 18% of the centers for unfavorable and favorable IR-patients, respectively. In terms of follow-up, 80%, 70% and 77% of the centers declared to systematically take into account patients’ weight, lipidic profile and CV status, respectively for follow-up under HT. To our knowledge this is the first survey on the patterns of practice of HT in IR prostate cancer. PROACT survey indicate that ¾ of the French centers declare to identify a subset of unfavorable IR-patients for a specific management. Only 10% of the centers use hypofractionated schedules (2-4Gy/fraction) and half of them include pelvic nodes for unfavorable IR cases. CV status of the patients is considered by the majority of centers as the main factor to determine the type of the drug to use and follow-up after therapy.