PD55-04 THE ERSPC VERSUS THE PROTECT STUDY: OUTCOMES AFTER ACTIVE SURVEILLANCE COMPARED TO SURGERY AND RADIOTHERAPY FOR LOCALIZED PROSTATE CANCER.

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2017PD55-04 THE ERSPC VERSUS THE PROTECT STUDY: OUTCOMES AFTER ACTIVE SURVEILLANCE COMPARED TO SURGERY AND RADIOTHERAPY FOR LOCALIZED PROSTATE CANCER. Frank-Jan Drost, Arnout Alberts, Chris Bangma, Monique Roobol, and for the ERSPC Rotterdam group Frank-Jan DrostFrank-Jan Drost More articles by this author , Arnout AlbertsArnout Alberts More articles by this author , Chris BangmaChris Bangma More articles by this author , Monique RoobolMonique Roobol More articles by this author , and for the ERSPC Rotterdam groupfor the ERSPC Rotterdam group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2427AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The safety of active surveillance (AS) remains topic of debate, but must be evaluated in light of results from the ′golden standard′ therapies, e.g. radiotherapy (RT) and radical prostatectomy (RP). The ProtecT study published 10-yr outcomes after randomization to active monitoring (AM), RT or RP; with higher risk patients and a less strict follow-up protocol than contemporary AS. In the European Randomized study of Screening for Prostate Cancer (ERSPC) Rotterdam, a subgroup of patients also received AM/AS, although more often according to a strict protocol (e.g. PRIAS). METHODS We evaluated death rates among men with low to intermediate risk prostate cancer (PC) treated with AS, RT or RP in the ERSPC and compared these to ProtecT. Men with low risk (Gleason score (GS) 6, cT1C/cT2A) and intermediate risk (GS ≤3+4, cT1c/cT2) PC, diagnosed in the 1st and 2nd screening round (1993-2003) were included. Controlling for age, PSA, clinical stage, GS and comorbidities, we performed cox proportional hazard analyses. RESULTS Of the 2280 PC patients, 905 and 1275 had low and intermediate risk PC, resp. Median age and PSA were 66.4 yrs and 4.3 ng/mL; 66,6 yrs and 4.5 ng/mL, resp. Median follow-up was 13 yrs. In the low risk group, the hazard ratio (HR) for PC specific death for RT/RP (n=370/312) vs AS (n=223) was 0.61 (95%CI 0.18-2, p=0.41). The HR for overall death was 1.29 (95% CI 0.97-1.72).In the intermediate risk group, the HR for PC specific death for RT/RP (n=501/526) vs AS (n=248) was 0.65 (95%CI 0.25-1.64, p=0.36). The HR for overall death was 1.23 (95% CI 0.95-1.59). See Figure 1.In the ProtecT study, the HR for PC specific death for RT vs. AM was 0.51 (95% CI 0.15-1.69) and for RP vs. AM 0.63 (95% CI 0.21-1.93), p=0.48. The HR for overall death was not specified (p=0.87 across treatment groups). CONCLUSIONS The HR for PC specific death for AS vs immediate active therapy, between the ERSPC Rotterdam and ProtecT, seem comparable. Although the ERSPC was not randomized, but includes 13 yr complete follow-up and consensus based cause of death assignment, these data confirm that AS as an initial treatment, as compared to immediate active therapy, results in similar low PC specific death rates. In the end, quality of life and hence the personal treatment preference of the patient should be decisive. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1052 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Frank-Jan Drost More articles by this author Arnout Alberts More articles by this author Chris Bangma More articles by this author Monique Roobol More articles by this author for the ERSPC Rotterdam group More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...