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Inicio Actas Urológicas Españolas (English Edition) Treatment trends for clinically localized prostate cancer. National population a...
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Vol. 40. Issue 4.
Pages 209-216 (May 2016)
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Vol. 40. Issue 4.
Pages 209-216 (May 2016)
Original article
Treatment trends for clinically localized prostate cancer. National population analysis: GESCAP group
Tendencias de tratamiento en el cáncer de próstata clínicamente localizado. Análisis poblacional a nivel nacional: grupo GESCAP
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B. Miñanaa,b,
Corresponding author
minana@gmail.com

Corresponding author.
, A. Rodríguez-Antolínc, F. Gómez-Veigad, C. Hernándeze, J.F. Suárezf, J.M. Fernández-Gómezg, M. Undah, J. Burgosi, A. Alcarazj, P. Rodríguezk, C. Morenol, E. Pedrosal, J.M. Cózarm, representing the Spanish Prostate Cancer Group (GESCAP)
a Departamento de Urología, Hospital Morales Meseguer, Murcia, Spain
b Cátedra de Urología, Universidad Católica San Antonio (UCAM), Murcia, Spain
c Hospital Universitario 12 de Octubre, Madrid, Spain
d Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
e Hospital Gregorio Marañón, Madrid, Spain
f Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
g Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
h Hospital de Basurto, Bilbao, Vizcaya, Spain
i Hospital Ramón y Cajal, Madrid, Spain
j Hospital Clínic i Provincial, Barcelona, Spain
k Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
l Departamento Médico, Astellas Pharma S. A., Madrid, Spain
m Hospital Virgen de las Nieves, Granada, Spain
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Tables (2)
Table 1. Distribution of cases based on the established treatments and D’Amico risk stratification (N=3293).
Table 2. Distribution of cases based on the established treatments according to the D’Amico risk stratification and the age groups (N=3276).
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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).

Keywords:
Prostate cancer
Treatment
Guidelines
Spain
Resumen
Objetivos

Describir las terapias establecidas para el cáncer de próstata (CaP) localizado en España y valorar el cumplimiento de las guías EAU 2010.

Pacientes y métodos

Estudio epidemiológico, observacional, prospectivo y multicéntrico. De los 3.918 pacientes diagnosticados con CaP durante 2010, solo se incluyeron los pacientes con CaP localizado. Finalmente, se hizo el seguimiento durante un periodo mínimo de un año a partir del diagnóstico a 3.713 pacientes (94,77%). Los grupos de tratamiento evaluados fueron: prostatectomía radical, radioterapia, terapia hormonal, braquiterapia, vigilancia activa u observación y tratamiento local experimental (crioterapia u otro tratamiento). Se estudió el cumplimiento de las recomendaciones de las guías EAU describiendo los grupos de tratamiento según los criterios de estratificación de riesgo de D’Amico (localizado [bajo riesgo, riesgo intermedio y alto riesgo] y localmente avanzado), edad, PSA y puntuación Gleason.

Resultados

Considerando los criterios D’Amico, se incluyó a 3.641 (92,93%) pacientes. Según las recomendaciones EAU: 1) se hizo prostatectomía radical al 68,87% de los pacientes de riesgo bajo-intermedio de65 años; 2) se administró radioterapia y terapia hormonal al 34,51% de los pacientes con riesgo alto-enfermedad localmente avanzada>65 años; 3) se trató solo con terapia hormonal al 30,36% de los pacientes con riesgo alto-enfermedad localmente avanzada; 4) recibieron solo braquiterapia el 15,20% de los pacientes con riesgo bajo; 5) se eligió la vigilancia activa u observación en el 2,44% de los pacientes65 años y en el 10,63% de los pacientes de riesgo bajo-intermedio>65 años. Por último, el 86,5% de los pacientes de bajo riesgo recibió un único tratamiento y el 43,62% de los pacientes con riesgo alto-enfermedad localmente avanzada recibió tratamientos combinados.

Conclusiones

Este es el primer estudio europeo de ámbito nacional que evalúa el manejo terapéutico para el CaP localizado en función del grupo de riesgo al que pertenece el paciente. La mayor parte de los pacientes jóvenes (≤65 años) con CaP localizado de riesgo bajo e intermedio fueron tratados con cirugía, lo cual se adapta a las recomendaciones de las guías de la EAU de 2010. En los pacientes con tumores localizados de alto riesgo y localmente avanzados se han empleado distintas combinaciones terapéuticas, poniendo de manifiesto la necesidad de un abordaje multidisciplinar (número de Controlled-trials.com ISRCTN19893319).

Palabras clave:
Cáncer de próstata
Tratamiento
Guías
España

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