Experiences of active surveillance (AS) treatment for organ confined prostate adenocarcinoma with very low, low or favourable intermediate risk patients based on the material of the PTE KK Urology Clinic
DOI: 10.22591/magyurol.2024.2.belakm.85
Authors:
Belák Mátyás dr.1, Cserjesi Zoé Lili2,
Damásdi Miklós dr.1, Szántó Árpád dr.1
1Pécsi Tudományegyetem KK, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
2Pécsi Tudományegyetem ÁOK, Pécs (dékán: Nyitrai Miklós dr.)
Summary
Introduction: Introduction: In our retrospective study, we mainly examined the data of patients with organ confined prostate cancer with very low, low or medium but favourable risk. Our clinical examination mainly focused on the frequency of the attending physician and his patient chose AS treatment in patients with the appropriate parameters, and which variables during the patient’s follow-up led to the decision to suspend AS or start active therapy.
Patients and methods: At the Urology Clinic of the University of Pécs, a total of 809 positive cases with a malignant histological patterns were confirmed by the prostate biopsy patient material performed between January 2015 and December 2020.
The selection of patients for the clinical trial was based on the urological guidelines of the EAU effective in 2021. During the 6-year study period, a total of 54 patients from the 809 positive patient samples met the criteria for AS. The average age of the 54 patients selected for AS treatment was 68 years (52–83), the average starting PSA value was 6.28 ng/ml (0.9–17.7), the average PSAD value was 0.16 ng/ml/cm3 (0.03–0.27), and 45 patients had ISUP1 and 9 ISUP2 histopathological grades. Out of the 54 selected patients, 24 patients progressed (40%) during the study period, the average follow-up time was 43 months (12–79), while the average time to progression was 27 months (12–48).
Results: At the time of withdrawal from AS treatment, the average PSA value of the patients was 7.8 ng/ml (1.1–12.1), the average PSAD value was 0.175 ng/ml/cm3 (0.022–0.291), and during the follow-up of the patients, only 48% (26/54) had PSA, imaging, and control biopsy as part of the follow-up at the same time. After withdrawal from AS, 8,3% (2/24) of patients received mono-ADT, 66.6% (16/24) received ADT and radiotherapy, 25% (6/24) received radical prostatectomy care.
During the processing of the results of the retrospective clinical examination carried out by our working group, we measured a slightly higher progression values as the literature data, the selection criteria corresponded to the effective European and domestic guidelines.
However, during follow-up, only 48% of patients could find the combined results of PSA, radiological and histological examinations. Although the short follow-up time, after an average of 43 months, falls short of the literary follow-up times of 5-10 years, it seems that the domestic practice is insufficient. The early withdrawal of patients from AS is mainly due to the monitored PSA values, instead the calculated PSA values (PSAD, velocity, PSAdt), radiological examinations (lack of multiparametric MRI), and histological results.
Conclusions: Based on literature data, more than a third of patients show progression (biochemical, radiological, histological) during AS, so it is reclassified into one of the active treatment strategies. Based on the currently effective 2023 EAU guidelines, the follow-up practice of patients in the AS patient group is still particularly heterogeneous; despite the fact that the recommendations are given, the selection and reclassification into active treatment takes place according to different conditions in each country and area. In our country, in the region we investigated, the number of AS treatments is still lacking.