The intermediate-risk (IR) prostate cancer (PCa) group is heterogeneous in terms of prognosis. For unfavorable or favorable IR PCa treated by radiotherapy, the optimal strategy remains to be defined. In routine practice, the physician's decision to propose hormonal therapy (HT) is controversial. The PROACT survey aimed to evaluate pattern and preferences of daily practice in France in this IR population.
A web questionnaire was distributed to French radiotherapy members of 91 centers of the Groupe d'Etude des Tumeurs Uro-Genitales (GETUG). The questionnaire included four sections concerning: (i) the specialists who prescribe treatments and multidisciplinary decisions (MTD) validation; (ii) the definition of IR subsets of patients; (iii) radiotherapy parameters; (iv) the pattern of practice regarding cardiovascular (CV) and (iv) metabolic evaluation. A descriptive presentation of the results was used.
Among the 82 responses (90% of the centers), HT schedules and irradiation techniques were validated by specific board meetings in 54% and 45% of the centers, respectively. Three-fourths (76%) of the centers identified a subset of IR patients for a dedicated strategy. The majority of centers consider PSA>15 (77%) and/or Gleason 7 (4+3) (87%) for an unfavorable IR definition. Overall, 41% of the centers performed systematically a CV evaluation before HT prescription while 61% consider only CV history/status in defining the type of HT. LHRH agonists are more frequently prescribed in both favorable (70%) and unfavorable (98%) IR patients. Finally, weight (80%), metabolic profile (70%) and CV status (77%) of patients are considered for follow-up under HT.
To the best of our knowledge, this is the first survey on HT practice in IR PCa. The PROACT survey indicates that three-quarters of the respondents identify subsets of IR-patients in tailoring therapy. The CV status of the patient is considered in guiding the HT decision, its duration and type of drug.
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique. 2020 Oct 31 [Epub ahead of print]
Y Belkacemi, I Latorzeff, A Hasbini, G Coraggio, D Pasquier, A Toledano, C Hennequin, A Bossi, O Chapet, G Crehange, S Guerif, T Duberge, N Allouache, P Clavere, E Gross, S Supiot, D Azria, M Bolla, P Sargos
AP-HP, hôpitaux universitaires Henri-Mondor, Inserm U955 (équipe 21), IMRB, université Paris-Est Créteil, CHU de Henri-Mondor, 51, avenue Mal-De-Lattre-de-Tassigny, 94000 Créteil, France. Electronic address: ., Clinique Pasteur, Toulouse, France., Clinique Pasteur, Brest, France., AP-HP, hôpitaux universitaires Henri-Mondor, Inserm U955 (équipe 21), IMRB, université Paris-Est Créteil, CHU de Henri-Mondor, 51, avenue Mal-De-Lattre-de-Tassigny, 94000 Créteil, France., Centre OscarLambret, CHRU de Lille, Lille, France., Clinique Hartmann, Neuilly-sur-Seine, France., Hôpital Saint-Louis, AP-HP, Paris, France., Institut Gustave-Roussy, Villejuif, France., CHU Lyon-Sud, Lyon, France., Institut Curie/René Huguenin, Paris/Saint Cloud, France., CHU de Poitiers, Poitiers, France., Croix-Rouge française, Toulon, France., Centre François-Baclesse, Caen, France., CHU de Limoges, Limoges, France., Ramsay-Générale de santé, hôpital privé Clairval, Marseille, France., Institut de cancérologie de l'Ouest, Saint-Heblain, France., ICM, Montpellier, France., CHU de Grenoble, Grenoble, France., Institut Bergonie, Bordeaux, France.