.: ORİJİNAL ARAŞTIRMA
The Active Surveillance for Low-risk Prostate Cancer: Case Series of Single Center
Düşük Riskli Prostat Kanserleri İçin Aktif İzlem: Tek Merkezin Olgu Serisi
J Reconstr Urol. 2021;11(2):73-8
doi: 10.5336/urology.2021-81636
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Up to 80% of prostate cancer cases are indolent that pose a minimal risk for morbidity and mortality throughout the life of the patient. Cancer-specific survival of the patients just followed up and those who received curative treatment were found to be similar, especially in the low-risk category. Active surveillance was described to preserve the quality of life of the patients and to protect them from the side effects of curative treatments. It has become increasingly used in low and very low risk. Although there are many studies on this subject with a large number of patients in the literature, we aimed to present our first results in this study. Material and Methods: The data of the patients, that were included in the active surveillance program between January 2012 and April 2020, were retrospectively analyzed. The patients were diagnosed with low-risk prostate cancer according to D'Amico criteria (International Society of Urological Pathology grade group 1, prostate-specific antigen <10 ng/mL, stage cT1c-T2a) via a minimum 12 core transrectal ultrasound guided prostate biopsy due to suspicious digital rectal examination and/or prostate-specific antigen elevation. Results: Thirty-six patients, who preferred active surveillance were included in the study. The mean age and prostate-specific antigen values of the patients were 66.38±8.02 years and 5.63±2.3 ng/mL, respectively. The median follow- up was 18.4 (minimum 1.63-maximum 82.4) months. In the initial biopsy, the cancer was detected in one core in 25 (69.4%), two cores in 10 (27.8%), and three cores in one (2.8%) of the patients. A total of 7 (19.4%) cases had received curative treatment. 3 cases had progression in pathological parameters and 4 cases chose to have active treatment. Conclusion: Our initial results with active surveillance are similar to the literature. Per the literature, the number of patients that chose active surveillance has increased.
Keywords: Prostate biopsy; cancer; surveillance
Objective: Up to 80% of prostate cancer cases are indolent that pose a minimal risk for morbidity and mortality throughout the life of the patient. Cancer-specific survival of the patients just followed up and those who received curative treatment were found to be similar, especially in the low-risk category. Active surveillance was described to preserve the quality of life of the patients and to protect them from the side effects of curative treatments. It has become increasingly used in low and very low risk. Although there are many studies on this subject with a large number of patients in the literature, we aimed to present our first results in this study. Material and Methods: The data of the patients, that were included in the active surveillance program between January 2012 and April 2020, were retrospectively analyzed. The patients were diagnosed with low-risk prostate cancer according to D'Amico criteria (International Society of Urological Pathology grade group 1, prostate-specific antigen <10 ng/mL, stage cT1c-T2a) via a minimum 12 core transrectal ultrasound guided prostate biopsy due to suspicious digital rectal examination and/or prostate-specific antigen elevation. Results: Thirty-six patients, who preferred active surveillance were included in the study. The mean age and prostate-specific antigen values of the patients were 66.38±8.02 years and 5.63±2.3 ng/mL, respectively. The median follow- up was 18.4 (minimum 1.63-maximum 82.4) months. In the initial biopsy, the cancer was detected in one core in 25 (69.4%), two cores in 10 (27.8%), and three cores in one (2.8%) of the patients. A total of 7 (19.4%) cases had received curative treatment. 3 cases had progression in pathological parameters and 4 cases chose to have active treatment. Conclusion: Our initial results with active surveillance are similar to the literature. Per the literature, the number of patients that chose active surveillance has increased.
Keywords: Prostate biopsy; cancer; surveillance
ÖZET
Prostat kanseri vakalarının %80 kadarı indolenttir. Hastanın yaşamı boyunca morbidite ve mortalite için minimum risk oluştururlar. Sadece takip edilenler ile küratif tedavi alan hastaların kansere özgü sağ kalımları, özellikle düşük risk kategorisinde benzer bulunmuştur. Aktif izlem, hastaların yaşam kalitesini korumanın yanı sıra onları küratif tedavilerin yan etkilerinden korumak için tanımlandı. Aktif izlem, düşük ve çok düşük riskte giderek daha fazla kullanılmaktadır. Literatürde, bu konuda çok sayıda hasta ile birçok çalışma olsa da çalışmamızda ilk sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: Ocak 2012 ile Nisan 2020 tarihleri arasında aktif izlem programına alınan hastaların verileri retrospektif olarak değerlendirildi. Hastalara, şüpheli dijital rektal muayene ve/veya prostat-spesifik antijen seviyesinin yükselmesi nedeniyle minimum 12 kor transrektal ultrason kılavuzluğunda prostat biyopsisi yapılmış olup, D'Amico kriterlerine göre düşük riskli prostat kanseri (International Society of Urological Pathology grade group 1, prostat-spesifik antijen <10 ng/mL, evre cT1c-T2a) teşhisi konulmuştur. Bulgular: Çalışmaya, aktif izlemi tercih eden 36 hasta dâhil edildi. Hastaların ortalama yaş ve prostat spesifik antijen değerleri sırasıyla 66,38±8,02 yıl ve 5,63±2,3 ng/mL idi. Ortanca takip süresi 18,4 (minimum 1,63-maksimum 82,4) aydı. İlk biyopside hastaların 25'inde (%69,4) 1, 10'unda (%27,8) 2 ve 1'inde (%2,8) 3 odakta kanser tespit edilmişti. Toplam 7 (%19,4) vaka, küratif tedavi almıştı. Üç vaka, patolojik parametrelerde ilerleme gösterdi ve 4 vaka, aktif tedavi olmayı seçti. Sonuç: Aktif izlemde ilk sonuçlarımız, literatür ile benzerdir ve kliniğimizde, aktif izlemi tercih eden hasta sayısı artmaktadır.
Anahtar Kelimeler: Prostat biyopsisi; kanser; izlem
Prostat kanseri vakalarının %80 kadarı indolenttir. Hastanın yaşamı boyunca morbidite ve mortalite için minimum risk oluştururlar. Sadece takip edilenler ile küratif tedavi alan hastaların kansere özgü sağ kalımları, özellikle düşük risk kategorisinde benzer bulunmuştur. Aktif izlem, hastaların yaşam kalitesini korumanın yanı sıra onları küratif tedavilerin yan etkilerinden korumak için tanımlandı. Aktif izlem, düşük ve çok düşük riskte giderek daha fazla kullanılmaktadır. Literatürde, bu konuda çok sayıda hasta ile birçok çalışma olsa da çalışmamızda ilk sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: Ocak 2012 ile Nisan 2020 tarihleri arasında aktif izlem programına alınan hastaların verileri retrospektif olarak değerlendirildi. Hastalara, şüpheli dijital rektal muayene ve/veya prostat-spesifik antijen seviyesinin yükselmesi nedeniyle minimum 12 kor transrektal ultrason kılavuzluğunda prostat biyopsisi yapılmış olup, D'Amico kriterlerine göre düşük riskli prostat kanseri (International Society of Urological Pathology grade group 1, prostat-spesifik antijen <10 ng/mL, evre cT1c-T2a) teşhisi konulmuştur. Bulgular: Çalışmaya, aktif izlemi tercih eden 36 hasta dâhil edildi. Hastaların ortalama yaş ve prostat spesifik antijen değerleri sırasıyla 66,38±8,02 yıl ve 5,63±2,3 ng/mL idi. Ortanca takip süresi 18,4 (minimum 1,63-maksimum 82,4) aydı. İlk biyopside hastaların 25'inde (%69,4) 1, 10'unda (%27,8) 2 ve 1'inde (%2,8) 3 odakta kanser tespit edilmişti. Toplam 7 (%19,4) vaka, küratif tedavi almıştı. Üç vaka, patolojik parametrelerde ilerleme gösterdi ve 4 vaka, aktif tedavi olmayı seçti. Sonuç: Aktif izlemde ilk sonuçlarımız, literatür ile benzerdir ve kliniğimizde, aktif izlemi tercih eden hasta sayısı artmaktadır.
Anahtar Kelimeler: Prostat biyopsisi; kanser; izlem
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