Lokalize prostat kanseri için aktif izlemde hangi aşamadayız? Klinik deneyimimiz

Abstract

Amaç: Prostat kanseri (PCa) erkeklerde en sık görülen bir malignitedir ve taramayla erken tanı konulabilir. Aktif izlem (Aİ), düşük riskli prostat kanserli (DRPK) hastalarda tedavi yönetimi seçeneklerinden biridir. Bu çalışmada prostat kanserinde Aİ ile ilgili klinik deneyimimizi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Ocak 2014 ile Aralık 2019 tarihleri ​​arasında PCa tanısı konan 1650 hastanın verileri retrospektif olarak incelendi. Dahil edilme kriterleri; 75 yaş altı olma ve 10 yıllık yaşam beklentisi mevcudiyeti, klinik T1-T2a evre, PSA düzeyi <10 ng/dl, biyopsi kor ≤2 pozitif olmak ve biyopsi örneğinin patolojik incelemesinin sonucu olarak Gleason skoru ≤6 olunması olarak tanımlandı. Dahil edilme kriterlerinden herhangi birini karşılamayan hastalar çalışma dışı bırakıldı. Bulgular: Dahil etme ve hariç tutma kriterlerinden sonra 176 hasta Aİ’i kabul etti ve çalışmaya dahil edildi. Ortalama takip süresi 25,2 ± 13 aydı. Toplam 57 hasta (32,3%) kesin tedavi için Aİ programından ayrıldı. Kesin tedavi 38 (65,5%) hastada radikal prostatektomi, 18 (31%) hastada radyoterapi ve bir (1,7%) hastada hormonoterapi idi. Sonuç: Aİ, DRPK hastalarında kesin tedavinin komplikasyonlarını önlemeye yardımcı olan bir yöntemdir. Bu hastalarının yönetiminde kesin tedaviye alternatif bir seçenek olarak kullanılabilir. Ancak Aİ hastalarının 30%’unda definitif tedavi ihtiyacı doğuran patolojik upgrade’ler olabileceği unutulmamalıdır.

Keywords

• Prostat kanseri
• Aktif izlem
• Düşük riskli prostat kanseri

At what stage are we in active surveillance for localized prostate cancer? Our clinical experience

Abstract

Objective: Prostate cancer (PCa) is the most common malignancy in men and early diagnosis can be made by screening. Active surveillance (AS) is one of the options for disease management in patients with low-risk prostate cancer (LRPC). In this study, we aimed to evaluate our clinical experience in AS for prostate cancer. Material and Methods: Data from 1650 patients who were diagnosed with PCa in the period between January 2014 and December 2019, were retrospectively reviewed. Inclusion criteria were defined as being under 75 years of age and having a 10-year life expectancy, being at clinical stages of T1-T2a, having a PSA level of <10 ng/dl, having positive biopsy cores of ≤2, and having a Gleason score of ≤6 as the result of the pathological examination of the biopsy specimen. Patients not meeting any of the inclusion criteria were excluded from the study. Results: After the inclusion and exclusion criteria, 176 patients agreed to undergo AS and were included in the study. The mean follow-up duration was 25.2 ± 13 months. A total of 57 patients (32.3%) left the AS program to undergo definitive treatment. Definitive treatment was radical prostatectomy in 38 (65.5%) patients, radiotherapy in 18 (31%) patients, and hormonotherapy in one (1.7%) patient. Conclusion: AS is a method that helps avoid the complications of definitive treatment in LRPC patients. It can be used as an alternative option to definitive treatment in the management of these patients. However, it should not be forgotten that pathological upgrades may occur in 30% of AS patients, indicating the need for definitive treatment.

Keywords

• Prostate cancer
• Active surveillance
• Low-risk prostate cancer

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