intermediate-risk prostate cancer role of surgery · cancer 2010;116 stattin p, et al. j natl...
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INTERMEDIATE-RISKPROSTATE CANCERROLE OF SURGERY
KARIM TOUIJER, MD, MPH
ATTENDING SURGEON
MEMORIAL SLOAN KETTERING CANCER CENTER
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INTERMEDIATERISKPROSTATE CANCER
HETEROGENEOUS GROUP
FAVORABLE INTERMEDIATE RISK
UNFAVORABLE INTERMEDIATE RISK
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Zumzteg et al. BJU Int 2017 (120)
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FAVORABLE INTERMEDIATERISK
ACTIVE SURVEILLANCE ?
FOCAL THERAPY ?
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ACTIVE SURVEILLANCEFOR INTERMEDIATE-RISK CAP
Carlsson et al. AUA abstract 2018Cooperberg JCO 2011, 29(2)
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TOTAL LENGTH OF GLEASON PATTERN 4ON BIOPSY
Dean et al. J Urol 2019 Jan 201
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UNFAVORABLE INTERMEDIATERISK
SURGERY ?
RADIATION THERAPY + ADT
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RANDOMIZEDCLINICALTRIAL PROTECT
Hamdy et al NEJM 2016;375
A
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RANDOMIZED CLINICAL TRIAL:PROTECT
LARGELY LOW-RISK POPULATION
CANCER SPECIFIC MORTALITY : NO DIFFERENCE
METASTATIC PROGRESSION: NO DIFFERENCE
Hamdy F et al. N Engl J Med 2016; 375:1415-
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OBSERVATIONAL STUDIES
MORE THAN 10 STUDIES IN THE PAST 10 YEARS
ACADEMIC, COMMUNITY, POPULATION BASED
TWOFOLD RISK ADJUSTED SURVIVAL ADVANTAGE OF RP OVER EBRT
Tewari A, et al. J Urol 2007;177 Albertsen PC et al. J Urol 2007;177. Zelefsky MJ, et al. J Clin Oncol 2010;28 Cooperberg MR. Cancer 2010;116 Stattin P, et al. J Natl Cancer Inst 2010;102 Boorjian SA, et al. Cancer 2011;117 Kibel A, et al.J Urol 2012;187. Hoffman RM, et al. J Natl Cancer Inst 2013;105Sun M, et al. BJU Int 2014;113. Sooriakumaran P, et al. BMJ 2014;348.
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OBSERVATIONAL STUDIES
STUDY YEAR SITE DATA CONCLUSIONS
Tewari et al. 2007 Henry ford CSM HR 0.5 (0.3-1.0) favoring RP over EBRTAlbertsen et al. 2007 CT registry CSM RR 2.5 (1.7-3.5) favoring RP over EBRTZelefsky et al. 2010 MSKCC CSM HR 2.2 (1.3-7.7) favoring RP over EBRTCooperberg et al. 2010 CaPSURE CSM HR 2.2 (1.5-3.2) favoring RP over EBRTStattin el al. 2010 NPCR CSM HR 1.4 (0.9-2.0) favoring RP over EBRTBoorjian et al. 2011 Mayo/FC CSM HR 1.1 (0.7-1.9) NS. For RP vs. EBRTKibel et al. 2012 WashU/CCF CSM HR 1.5 (1.0-2.3) favoring RP over EBRTHoffman et al. 2013 PCOS CSM HR 2.9 (2.0-3.8) favoring RP over EBRTSun et al. 2014 SEER CSM HR 2.5 (1.5 – 4.2) favoring RP over EBRTSooriakumaran et al.
2014 PCBase CSM HR 1.8 (1.5-2.0) favoring RP over EBRT
Tewari A, et al. J Urol 2007;177 Albertsen PC et al. J Urol 2007;177. Zelefsky MJ, et al. J Clin Oncol 2010;28 Cooperberg MR. Cancer 2010;116 Stattin P, et al. J Natl Cancer Inst 2010;102 Boorjian SA, et al. Cancer 2011;117 Kibel A, et al.J Urol 2012;187. Hoffman RM, et al. J Natl Cancer Inst 2013;105Sun M, et al. BJU Int 2014;113. Sooriakumaran P, et al. BMJ 2014;348.
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Zelefsky MJ, et al. J Clin Oncol 2010;28
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Berlin j et al. J Urol; 2019 (feb) 201.
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Berlin j et al. J Urol; 2019 (feb) 201.
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QOL
Donovan et al . NEJM 2016 , 375
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QOL
Donovan et al . NEJM 2016 , 375
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QOL
Donovan et al . NEJM 2016 , 375
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QOL
Donovan et al . NEJM 2016 , 375
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QOL
Donovan et al . NEJM 2016 , 375
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CONCLUSIONS
NO LEVEL I EVIDENCE
ONCOLOGICAL OUTCOMES FAVOR SURGERY
QOL DATA FAVOR RADIATION THERAPY THOUGH BOWEL TOXICITY IS WORSE WITH RT