ESOU18: Treatment Modalities for Intermediate Risk Prostate Cancer - Surgery

Amsterdam, The Netherlands (UroToday.com) Intermediate prostate cancer (IRPC) is defined according to the D’Amico risk classification system, as PSA 10-20, Gleason score (GS) 7 or clinical stage T2b. The risk of lymph node invasion in patients with IRPC ranges between 14.4%-20.1%. The SPCG-4 trial, comparing watchful waiting to radical prostatectomy, demonstrated that the benefit of surgery was the largest in men younger than 65 and in those with IRPC1 (Figure 1). However, in the PIVOT trial, comparing prostatectomy vs. observation in early PC, after 20 years of follow-up, surgery was not associated with significantly lower all-cause or PC-mortality, than observation2 (Figure 2).

In conclusion, IRPC patients represent a heterogenous patient group, which require sub-stratification. Surgery impacts on the natural history of IRPC and the long-term outcomes of surgery in this groups are in general excellent. However, patients with favorable disease characteristics might be spared radical treatment (at least initially), and could probably be monitored at first stage.

 Figure 1: SPCG-4 trial demonstrating outcomes of younger men and those with intermediate risk prostate cancer:
Surg1

Figure 2: PIVOT trial – comparing death from any cause and death from prostate cancer between patients treated with observation and those treated with Radical prostatectomy:
Surg2

Speaker:
Steven Joniau, MD, PhD, Associate Professor, Consultant Urologist Department of Urology University Hospitals Leuven, Belgium.

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands

References:

  1. Bill-Axelson  A, Holmberg  L, Garmo  H, et al. Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer. New England Journal of Medicine 2014; 370(10): 932-42.
  2. Wilt TJ, Jones KM, Barry MJ, et al. Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. New England Journal of Medicine 2017; 377(2): 132-42.
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