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EAU 2017

EAU 2017: Observation or active surveillance or curative treatment: What do SPCG-4 data tell us?

London, England (UroToday.com) The SPC-4 was a randomized study performed between 1989 and 1999, including 695 men and comparing radical prostatectomy (RP) and watchful waiting in patients with localized prostate cancer. The study involved 14 centers in Sweden, Finland and Iceland. All men were younger than 75, with localized tumor and stage T1b and T2, with moderate to highly differentiated tumors, with M0 at bone scan, and PSA less than 50 ng/ml. Last follow-up was in 2012 after 23 years of follow-up, and the next update is due in December 2017.

Results showed that RP in this study reduced prostate cancer specific and overall mortality by 12% and 13%, respectively. RP also reduced the risk of metastases and androgen deprivation therapy (ADT) by 12% and 26%, respectively.

When looking at the prostatectomy specimens, 46% and 35% had extracapsular extension and positive surgical margins, respectively. In total, patients in the SPCG-4 study were clinically detected as having more advanced tumor than today.

Subgroup analyses performed showed that in men older than 65 years and men with low risk prostate cancer had no significant survival benefit when treated with RP. Quality of life parameters were highest at the observation group.

To conclude, active surveillance is possible in select patient groups and it defers treatment side effects. The future trial SPCG-17 aims to reduce overtreatment and make AS safe. This study will include 2000 patients from Sweden, Finland, Norway and the UK. PSA will be examined every 6 months, yearly checkups will be included and prostate MRI will occur every 2nd year. The primary endpoint will be progression free survival and the first analysis will be 1 year after inclusion.

Presented by: Dr. Anna Bill-Axelson, Uppsala (SE)

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto

Twitter: @GoldbergHanan

at the #EAU17 -March 24-28, 2017- London, England