Treatment or Monitoring for Early Prostate Cancer
Ce dossier présente deux études menées auprès de 1 643 patients atteints d'un cancer de la prostate de stade localisé (durée médiane de suivi : 10 ans), l'une comparant l'intérêt, du point de vue notamment de la mortalité spécifique et de la progression de la maladie, d'une prostatectomie radicale, d'une radiothérapie externe et d'une surveillance active, l'autre les effets de ces stratégies thérapeutiques sur la qualité de vie auto-rapportée des patients
The “best” initial approach to early (low-risk or intermediate-risk)1 prostate cancer remains unknown. Specifically, does active monitoring with the use of prostate-specific antigen (PSA) testing as opposed to treatment lead to increased metastasis and death from prostate cancer? If yes, then which treatment, radical prostatectomy or radiation with or without short-term (3 to 6 months) androgen-suppression therapy, minimizes metastasis and death from prostate cancer?
Hamdy and colleagues now report in the Journal the results of a randomized comparison of three of these four approaches after a median follow-up of 10 years,2 and Donovan and colleagues present data on patient-reported health-related quality of life at 6 years of follow-up.3 Men were screened with PSA testing and presented at a median age of 62 years with favorable clinical characteristics : 76% had stage T1c (PSA-detected) disease, 77% and 21% had tumors with Gleason scores of 6 and 7, respectively (on a scale from 6 to 10, with higher scores indicating a worse prognosis), and the median PSA level was 4.6 ng per milliliter. Although a median follow-up of 10 years was too short to evaluate the primary outcome of prostate-cancer mortality in this favorable cohort (death from prostate cancer occurred in 8 of the 545 men assigned to active monitoring, 5 of the 553 men assigned to surgery, and 4 of the 545 men assigned to radiotherapy), it was adequate to evaluate the secondary outcome of the incidence of metastatic disease, defined as bony, visceral, or lymph-node metastasis on imaging or a PSA level above 100 ng per milliliter.
New England Journal of Medicine , éditorial en libre accès, 2015