Treatment trends for clinically localized prostate cancer. National population analysis: GESCAP group

• Published in: Actas urológicas españolas (English ed.) 2016-05, Vol.40 (4), p.209-216
• Main Authors: Miñana, B, Rodríguez-Antolín, A, Gómez-Veiga, F, Hernández, C, Suárez, J.F, Fernández-Gómez, J.M, Unda, M, Burgos, J, Alcaraz, A, Rodríguez, P, Moreno, C, Pedrosa, E, Cózar, J.M
• Format: Article
• Language: English
• Subjects: Cáncer de próstata; España; Guidelines; Guías; Prostate cancer; Spain; Tratamiento; Treatment; Urology
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2016.02.013

Abstract Objectives To describe the established therapies for localized prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines. Patients and methods This was an epidemiological, observational, prospective and multicentre study. Of the 3918 patients diagnosed with PC during 2010, only those patients with localized PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D’Amico risk stratification criteria (localized [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score. Results By applying the D’Amico criteria, we included 3641 (92.93%) patients. Based on the UAE recommendations: (1) 68.87% of the patients at low-intermediate risk aged ≤65 years underwent radical prostatectomy; (2) 34.51% of the patients >65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; (3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; (4) 15.20% of the patients at low risk were only treated with brachytherapy; (5) active surveillance or observation was selected for 2.44% of the patients aged ≤65 years and for 10.63% of the patients at low-intermediate risk who were >65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments. Conclusions This is the first national European study to evaluate the therapeutic management of localized PC based on the risk group to which the patient belonged. Most young patients (≤65 years) with low-intermediate risk localized PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localized tumors, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319).