Letters to the Editor
Are we overtreating low risk prostate cancer?
¿Estamos sobretratando el cáncer de próstata de bajo riesgo?
C.D. Vera Donoso
Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Read
994
Timeswas read the article
219
Total PDF
775
Total HTML
Share statistics
array:24 [ "pii" => "S2173578612000297" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2011.06.016" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "aid" => "337" "copyright" => "AEU" "copyrightAnyo" => "2011" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Urol Esp. 2012;36:66" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 998 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 774 "PDF" => 217 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480611002841" "issn" => "02104806" "doi" => "10.1016/j.acuro.2011.06.018" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "aid" => "337" "copyright" => "AEU" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Urol Esp. 2012;36:66" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2455 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 2032 "PDF" => 410 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "¿Estamos sobretratando el cáncer de próstata de bajo riesgo?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "66" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Are we overtreating low risk prostate cancer?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.D. Vera Donoso" "autores" => array:1 [ 0 => array:2 [ "nombre" => "C.D." "apellidos" => "Vera Donoso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578612000297" "doi" => "10.1016/j.acuroe.2011.06.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000297?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002841?idApp=UINPBA00004N" "url" => "/02104806/0000003600000001/v2_201304261300/S0210480611002841/v2_201304261300/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578612000200" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2011.06.010" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "aid" => "328" "copyright" => "AEU" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Urol Esp. 2012;36:67-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1517 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 1158 "PDF" => 350 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Management of primary carcinoma of the seminal vesicle" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del carcinoma primario de la vesícula seminal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 711 "Ancho" => 913 "Tamanyo" => 168875 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin stain at 20× magnification. Mucinous adenocarcinoma defined by the presence of large deposits of mucinous material (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R.L. Favaretto, M.C. Ercolani, R. Sánchez-Salas, P. Validire, E. Barret, X. Cathelineau" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R.L." "apellidos" => "Favaretto" ] 1 => array:2 [ "nombre" => "M.C." "apellidos" => "Ercolani" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Sánchez-Salas" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Validire" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Barret" ] 5 => array:2 [ "nombre" => "X." "apellidos" => "Cathelineau" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611002658" "doi" => "10.1016/j.acuro.2011.06.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002658?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000200?idApp=UINPBA00004N" "url" => "/21735786/0000003600000001/v1_201304251735/S2173578612000200/v1_201304251735/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578612000261" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2011.06.013" "estado" => "S300" "fechaPublicacion" => "2012-01-01" "aid" => "323" "copyright" => "AEU" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Urol Esp. 2012;36:65-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1042 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 829 "PDF" => 204 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Response of the Editor: The evidence of case reports in urology is, per se, scarcely defendable" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "66" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta del Director: la evidencia de los casos clínicos en Urología es, en sí misma, escasamente defendible" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Angulo" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Angulo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611002609" "doi" => "10.1016/j.acuro.2011.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002609?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000261?idApp=UINPBA00004N" "url" => "/21735786/0000003600000001/v1_201304251735/S2173578612000261/v1_201304251735/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letters to the Editor</span>" "titulo" => "Are we overtreating low risk prostate cancer?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "66" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "C.D. Vera Donoso" "autores" => array:1 [ 0 => array:3 [ "nombre" => "C.D." "apellidos" => "Vera Donoso" "email" => array:1 [ 0 => "cdveradonoso@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Estamos sobretratando el cáncer de próstata de bajo riesgo?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Spain, 18,872 new cases of prostate cancer (PCa) are detected every year, according to information from the first National Registry for Prostate Cancer (LXXVI Congress of Urology, Málaga, June 2011). Overdiagnosis and overtreatment are, very likely, the most significant adverse effects of PCa screening.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Despite therapeutic advances, the consequences of the disease and the treatment given itself affect the patient's quality of life for years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The recent annual congress of the American Urological Association, held in Washington, had an area that we could qualify as historic. On May 17, 2011, Dr. Timothy Wilt, professor of Medicine at the University of Minnesota, presented the results of the PIVOT study (Prostate Cancer Intervention Versus Observation Trial). Started in 1994, this study included 731 patients who agreed to be randomly subjected to radical prostatectomy (RP) or maintain watchful waiting (WW). In order to be eligible, patients had to be <75, have clinically localized PCa, and PSA <50<span class="elsevierStyleHsp" style=""></span>ng/ml. The average age was 67. The mean and median PSA were 10.2 and 7.8<span class="elsevierStyleHsp" style=""></span>ng/ml, respectively. According to the classification of tumor risk, approximately 40% had low-risk tumors, 33% intermediate-risk tumors, and 22% high-risk tumors.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At 12, 354 of the 731 men (48.4%) had died, with an absolute reduction in general mortality and disease-specific mortality of approximately 3% in the RP group compared to the WW group. In men with low-risk disease, there was an absolute difference in mortality of PCa between treatment groups of 1.4% for observation. But, in men with high-risk disease, the absolute difference was 8.4% for surgery (webcast on AUA website). The PIVOT shows that this ‘cancer’ does not imply an inexorable progression to metastasis and death.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The increasing number of men diagnosed with PCa in Spain involves serious consequences. It places the psychological burden of the cancer diagnosis on thousands of patients and generates an unnecessary fear in them. In addition, it distracts attention, time, and material resources that are needed to identify the tumors that require aggressive treatment. In a recent Spanish work, the low-risk group was 43.3% of the patients undergoing RP, 25.5% of whom received external radiotherapy, and 96.7% of the patients who received brachytherapy.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We must understand that this PIVOT study report is not ‘bad news’ but ‘good news’ because it points the way to be followed in the search for the truth and the benefit to our patients. Meanwhile, I propose some thoughts on what our attitude to follow should be:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0030" class="elsevierStylePara elsevierViewall">To accept that population screening and diagnostic examinations detect a considerable number of indolent tumors.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0035" class="elsevierStylePara elsevierViewall">To redefine what low-risk PCa really is. To consider the elimination of the use of the word ‘cancer’ and its replacement by a term like ‘IDLE tumor’ (indolent lesions of epithelial origin).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0040" class="elsevierStylePara elsevierViewall">To restrict the indication for prostate biopsies.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Genetics can help us differentiate between aggressive tumor phenotypes and indolent ones.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0050" class="elsevierStylePara elsevierViewall">To propose, as suggested by the National Comprehensive Cancer Network guidelines (NCCN), active or watchful surveillance as the first therapeutic option in low-risk patients.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Last, but not least, to convey reassurance to our patients with a tumor that, obviously, will not kill them.</p></li></ul></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Vera Donoso CD. ¿Estamos sobretratando el cáncer de próstata de bajo riesgo?. Actas Urol Esp. 2012;36:66.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer screening" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Hakama" 1 => "A. Auvinen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "International encyclopaedia of public health" "paginaInicial" => "464" "paginaFinal" => "480" "serieFecha" => "2008" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health related quality of life outcomes after radical prostatectomy: attention to study design and the patient-based importance of single-surgeon studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.L. Dalkin" 1 => "B.A. Christopher" 2 => "D. Shawler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urolonc.2005.05.009" "Revista" => array:6 [ "tituloSerie" => "Urol Oncol" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "28" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16414489" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo Multicéntrico Español de Cáncer de Próstata Organoconfinado" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Becerra Bachino" 1 => "F. Cots" 2 => "F. Guedea" 3 => "J. Pera" 4 => "A. Boladeras" 5 => "F. Aguiló" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2010.10.008" "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "35" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21316126" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Solving the overdiagnosis dilemma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Esserman" 1 => "I. Thompson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jnci/djq119" "Revista" => array:6 [ "tituloSerie" => "JNCI" "fecha" => "2010" "volumen" => "102" "paginaInicial" => "582" "paginaFinal" => "583" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20413743" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003600000001/v1_201304251735/S2173578612000297/v1_201304251735/en/main.assets" "Apartado" => array:4 [ "identificador" => "6306" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003600000001/v1_201304251735/S2173578612000297/v1_201304251735/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000297?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 2 | 3 |
| 2018 February | 9 | 2 | 11 |
| 2018 January | 6 | 1 | 7 |
| 2017 December | 6 | 0 | 6 |
| 2017 November | 4 | 1 | 5 |
| 2017 October | 11 | 2 | 13 |
| 2017 September | 7 | 1 | 8 |
| 2017 August | 12 | 2 | 14 |
| 2017 July | 18 | 1 | 19 |
| 2017 June | 5 | 1 | 6 |
| 2017 May | 3 | 1 | 4 |
| 2017 April | 11 | 2 | 13 |
| 2017 March | 6 | 28 | 34 |
| 2017 February | 3 | 1 | 4 |
| 2017 January | 6 | 0 | 6 |
| 2016 December | 21 | 2 | 23 |
| 2016 November | 17 | 9 | 26 |
| 2016 October | 31 | 7 | 38 |
| 2016 September | 16 | 2 | 18 |
| 2016 August | 25 | 2 | 27 |
| 2016 July | 20 | 4 | 24 |
| 2016 June | 18 | 5 | 23 |
| 2016 May | 18 | 16 | 34 |
| 2016 April | 17 | 8 | 25 |
| 2016 March | 24 | 9 | 33 |
| 2016 February | 20 | 10 | 30 |
| 2016 January | 26 | 14 | 40 |
| 2015 December | 27 | 6 | 33 |
| 2015 November | 15 | 4 | 19 |
| 2015 October | 25 | 9 | 34 |
| 2015 September | 15 | 3 | 18 |
| 2015 August | 8 | 4 | 12 |
| 2015 July | 12 | 1 | 13 |
| 2015 June | 2 | 1 | 3 |
| 2015 May | 6 | 3 | 9 |
| 2015 April | 13 | 8 | 21 |
| 2015 March | 16 | 5 | 21 |
| 2015 February | 9 | 1 | 10 |
| 2015 January | 16 | 3 | 19 |
| 2014 December | 30 | 3 | 33 |
| 2014 November | 10 | 1 | 11 |
| 2014 October | 29 | 7 | 36 |
| 2014 September | 30 | 3 | 33 |
| 2014 August | 24 | 3 | 27 |
| 2014 July | 25 | 2 | 27 |
| 2014 June | 9 | 4 | 13 |
| 2014 May | 9 | 1 | 10 |
| 2014 April | 10 | 4 | 14 |
| 2014 March | 23 | 2 | 25 |
| 2014 February | 11 | 1 | 12 |
| 2014 January | 9 | 1 | 10 |
| 2013 December | 8 | 2 | 10 |
| 2013 November | 12 | 3 | 15 |
| 2013 October | 5 | 1 | 6 |
| 2013 September | 6 | 0 | 6 |
Show all
