Therapy

Table 4 presents in detail the effects of combined T category on the choice of therapy. Guidelines [9] note that radical prostatectomy, radiation therapy and hormone therapy in combination with radiation therapy are the main primary treatment options when the tumour remains within the prostate capsule (T2) or does not invade nearby structures other than the seminal vesicles or the bladder neck (T3). A spreading prostate cancer should be treated with a hormone therapy. Active surveillance (AS) and watchful waiting (WW) are only note worthy initial therapy strategies for tumours detected in an early stage. Although these are accepted treatment options in localised prostate cancer, they are seldom chosen compared to radical prostatectomy and hormone therapy. Transurethral resection of the prostate is not an appropriate surgical treatment option in prostate cancer but its proportion in T1 category (46.7%) indicates a greater proportion of incidentally found prostate cancers during a treatment of benign hyperplasia. Without further surgical or hormone therapy, one could classify these cases into the AS or WW groups.

T3

T4

All

(n=1826 13.3%)

(n=8219 59.9%)

(n=3164 23.0%)

(n=503 3.7%)

(n=13712 100%)

Initial therapy RPE

74.9

65.9

31.3

61.8

TUR

47.2

3.2

2.5

11.4

9.0

HIFU

4.5

3.4

0.8

0.2

2.8

XRT

16.6

6.1

8

12.7

8.5

Hormone

23.7

11.6

20.3

44.2

16.4

AS and WW

8.0

0.8

0.7

0.2

1.6

Presented numbers are column-wise percentages. T category is a combination of cT and pT.

The disease cohort is limited to 2005-2009 to provide best current estimators.

RPE: radical prostatectomy, TUR: transurethral resection of the prostate, HIFU: high-intensity focused ultrasound, XRT: radiation therapy, Hormone: hormone therapy, AS: active surveillance, WW: watchful waiting

Presented numbers are column-wise percentages. T category is a combination of cT and pT.

The disease cohort is limited to 2005-2009 to provide best current estimators.

RPE: radical prostatectomy, TUR: transurethral resection of the prostate, HIFU: high-intensity focused ultrasound, XRT: radiation therapy, Hormone: hormone therapy, AS: active surveillance, WW: watchful waiting

Table 4. Initial therapy by T category [4]

As Figure 4 shows impressively, initial therapy strategies have changed noticeably over the last 20 years. In the late 1980's radical prostatectomy was the initial therapy in about 25% of all treatments. Its rate increased continuously and finally reaches almost 60%, making this the most selected initial therapy per year since 1995. The curve of hormone therapy developed oppositely. To be more precise: hormone therapy was the most selected treatment till 1994. From 65% in 1989 it continuously decreased to now 20%. Radiation therapy (XRT) slightly increased to 10% as initial therapy. Finally, within the whole time span transurethral resection of the prostate (TUR) remains stable at a proportion of nearly 10%.

Year

Figure 4. Distribution of initial therapy strategies over time (n = 35544) [4]. RPE: radical prostatectomy, XRT: radiation therapy, Hormone: hormone therapy, TUR: transurethral resection of the prostate

Year

Figure 4. Distribution of initial therapy strategies over time (n = 35544) [4]. RPE: radical prostatectomy, XRT: radiation therapy, Hormone: hormone therapy, TUR: transurethral resection of the prostate

0 0

Post a comment