Algemeen: Reguliere behandeling van prostaatkanker met chemo met bij diagnose relatief lage PSA is zinloos. De kans aan prostaatkanker te sterven met een Gleasonscore van minder dan 7 is 1 op de 100. Artikel geplaatst april 2006

Voor meest actuele informatie over nieuwste behandelingen en middelen bij prostaatkanker inclusief nuttige adressen, leest u het rapport prostaatkanker-actueel ook onder kankersoorten-prostaatkanker.

13 juni 2006: Bron: Br J Cancer. 2006 May 22;94(10):1361-8.

Mannen met door een scan vastgestelde prostaatkanker die bij de diagnose een lage PSA waarde hebben en een lage Gleason score zouden kunnen volstaan met regelmatige controle en geen radicale behandeling met operatie of bestraling of chemo of hormoontherapie. Niets doen is net zo effectief en uiteraard veel en veel minder belastend. Dat zijn de conclusies van een groot onderzoek dat in The British Journal of Cancer werd gepubliceerd deze week. Voor mannen met een Gleason score lager dan 7 bij de diagnose was het effect van een radicale behandeling op de 15 jarige overleving 0%. Voor mannen (in de leeftijd van 50 tot 55 jaar bij diagnose) met een hoge Gleasonscore van meer dan 7 bij de diagnose was er wel een positief effect van een radicale behandeling

Resultaten:

Mediane overleving bij mannen met prostaatkanker gediagnosteerd in de leeftijd tussen 55-59 was 14.1, 9.3 en 5.0 jaar respectievelijk voor mannen met Gleason scores lager dan 7, precies 7 en hoger dan 7, met in achtneming van twee jarige screening en 100% aandacht. Algemeen bleek de binnen 15-jaar prostaatkanker gerelateerde sterfte ondanks conservatieve behandeling van door scan aangetoonde prostaatkanker 0% tot 2% voor Gleason scores kleiner dan 7, 9% tot 31% voor Gleason score 7 en 28-72% voor Gleason scores hoger dan 7. Voor mannen in de leeftijd van 50 tot 55 jaar op moment van diagnose was het profijt/effect van een radicale genezende behandeling op de absolute 15 jaars overleving 0%, 12 % en 26% voor mannen met Gleason scores <7, 7 en >7, respectievelijk.

A model of the natural history of screen-detected prostate cancer, and the effect of radical treatment on overall survival.

Parker C, Muston D, Melia J, Moss S, Dearnaley D.

Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK. chris.parker@rmh.nhs.uk

De lead time and over-detection associated with prostate-specific antigen (PSA) screening, and generational improvements in all-cause mortality, make prostate cancer outcome studies from the pre-PSA era difficult to interpret in a contemporary setting. We developed a competing-risks hazard model to estimate the natural history of screen-detected prostate cancer, and the impact of radical treatment on overall survival. The model of hazard of mortality was fitted to clinical outcome data from the pre-PSA era, and the effects of screening, generational mortality improvements and radical treatment were incorporated. Sensitivities to the choice of baseline data and values of key parameters were assessed. Lead-time estimates in men diagnosed aged 55-59 years were 14.1, 9.3 and 5.0 years for men with Gleason scores <7, 7 and >7, respectively, assuming biennial screening with 100% attendance. Central estimates of 15-year prostate cancer mortality for conservative management of screen-detected prostate cancer ranged from 0 to 2% for Gleason scores <7, 9 to 31% for Gleason score 7 and 28-72% for Gleason scores >7. For men aged 55-59 years at diagnosis, the predicted absolute 15-year survival benefit from curative treatment was 0, 12 and 26% for men with Gleason scores <7, 7 and >7, respectively. Estimates of the survival benefit of radical treatment were relatively insensitive to values of key parameters. The case for curative treatment, rather than conservative management, of screen-detected localised prostate cancer is strongest in men with high-grade disease. This conclusion contrasts with current patterns of care The lead time and over-detection associated with prostate-specific antigen (PSA) screening, and generational improvements in all-cause mortality, make prostate cancer outcome studies from the pre-PSA era difficult to interpret in a contemporary setting. We developed a competing-risks hazard model to estimate the natural history of screen-detected prostate cancer, and the impact of radical treatment on overall survival. The model of hazard of mortality was fitted to clinical outcome data from the pre-PSA era, and the effects of screening, generational mortality improvements and radical treatment were incorporated. Sensitivities to the choice of baseline data and values of key parameters were assessed. Lead-time estimates in men diagnosed aged 55-59 years were 14.1, 9.3 and 5.0 years for men with Gleason scores <7, 7 and >7, respectively, assuming biennial screening with 100% attendance. Central estimates of 15-year prostate cancer mortality for conservative management of screen-detected prostate cancer ranged from 0 to 2% for Gleason scores <7, 9 to 31% for Gleason score 7 and 28-72% for Gleason scores >7. For men aged 55-59 years at diagnosis, the predicted absolute 15-year survival benefit from curative treatment was 0, 12 and 26% for men with Gleason scores <7, 7 and >7, respectively. Estimates of the survival benefit of radical treatment were relatively insensitive to values of key parameters. The case for curative treatment, rather than conservative management, of screen-detected localised prostate cancer is strongest in men with high-grade disease. This conclusion contrasts with current patterns of care.

PMID: 16641912 [PubMed - in process]