Personalizing the Duration of Androgen-Deprivation Therapy Use in the Management of Intermediate-Risk Prostate Cancer
Mené sur 1 489 patients atteints d'un cancer de la prostate à risque intermédiaire de récidive, cet essai évalue, du point de vue des taux de survie spécifique et de survie globale à 10 ans, l'intérêt d'augmenter de 8 à 28 semaines la durée d'un traitement anti-androgénique précédant une radiothérapie en combinaison avec un traitement anti-androgénique concomitant
When considering a risk-based scheme for predicting outcomes following standards of practice for nonmetastatic, node-negative prostate cancer (PC), men experience recurrence either infrequently or commonly, depending on their risk group, and some who recur will go on to die as a result of PC. However, men with intermediate-risk PC1 have been shown to have 5-year prostate-specific antigen (PSA) progression-free rates that range from 30% (a high-risk outcome) to 98% (a low-risk outcome).3 As a result of this variation, investigators have sought to identify clinical factors in addition to those on which intermediate risk1 is based (PSA > 10 to 20 ng/mL, Gleason score 7, or clinical tumor category 2b or 2c) to stratify these men into low- and high-risk subgroups for PC-specific mortality (PCSM). Multiple studies exist to show that the percent of positive prostate biopsies (ppb),4–7 the number of intermediate-risk factors,8 and primary versus secondary biopsy Gleason grade 4 in men with Gleason score 7 PC9 can aid in making this stratification. On the basis of these data, investigators from Memorial Sloan Kettering proposed two intermediate-risk subgroups as follows10: (1) Favorable—Gleason 3 + 4 or less and ppb not exceeding 50% and only one intermediate-risk factor excluding 4 + 3; and (2) Unfavorable—Gleason 4 + 3 or at least two intermediate-risk factors or at least one intermediate risk factor and ppb greater than 50%.
Journal of Clinical Oncology , éditorial en libre accès, 2014