Historia natural del cáncer de próstata localizado. datos preliminares de progresión y mortalidad

Resumen

Objetivo

Conocer el impacto de la alternativa terapéutica y de otros factores sobre la historia natural del cáncer de próstata (CaP) localizado.

Métodos

Pacientes con CaP clínicamente localizado sometidos a prostatectomía radical (PR), radioterapia (RT) u observación (OBS). Se calcularon las tasas de progresión bioquímica (PBQ) y clínica (PCL). Se evaluaron los efectos del tratamiento, del PSA al diagnóstico, de la presencia de tumor palpable y del score de Gleason mediante análisis Kaplan- Meier y test log-rank. Del mismo modo se estudiaron la mortalidad global y la cáncer específica.

Resultados

Se estudiaron 228 pacientes (135 sometidos a PR, 46 a RT, y 47 a OBS). La mediana del tiempo de seguimiento fue de 2,5 años. Cuarenta pacientes presentaron PBQ. La probabilidad de permanecer libre de PBQ a los 2 y 5 años fue de 76,8% y 57,9% respectivamente para la serie completa, 70,9% y 57,6% para PR, 100% y 100% para RT, y 87,1% y 47,2% para OBS (p=0,031). Diecinueve pacientes presentaron PCL, no observándose diferencia significativa respecto del tratamiento efectuado. Un score de Gleason pobremente diferenciado influyó en la probabilidad de presentar PCL (p=0,022) y en la evolución a enfermedad metastásica (p0,001). No se registró mortalidad cáncer-específica en la población estudiada.

Conclusiones

Natural History Of Localized Prostate Cancer. Preliminary Data On Progression And Mortality

Abstract

Objective

To address the effect of therapy options and other factors on the natural history of localized prostate cancer (PCa).

Methods

Men with diagnosed clinically localized PCa who underwent radical prostatectomy (RP), radiotherapy (RT) or watchful waiting (WW). Rates of biochemical progression (BQP) and clinical progression (CLP) were calculated. The effects of therapy, initial PSA, presence of palpable tumor and Gleason score were assessed with Kaplan-Meier analysis and log-rank test. Similar methods were used to study overall and disease-specific survival.

Results

A total of 228 patients were studied (135 underwent RP, 46 RT, and 47 WW). Median followup time was 2.5 years. Forty patients presented with BQP. The probability of being free from BQP after 2 and 5 years was 76.8% and 57.9% respectively for the whole population, 70.9% and 57.6% for RP patients, 100% and 100% for RT, and 87.1% and 47.2% for WW (p=0.031). Nineteen patients presented with CLP, with no significant differences with regard to therapy option. A poorly differentiated Gleason score favoured the probability of presenting with CLP (p=0.022) and shift to metastatic disease (p0.001). No cancer-specific mortality was recorded in the studied population.

Conclusions

Short and medium term prognosis is excellent for localized prostate cancer in terms of survival. Nevertheless, some patients show a higher risk of progressing to metastatic disease (poorly differentiated Gleason score).