Cours nationaux de DES de Radiothérapie oncologique Nancy – 2 au 4 février 2012 Alberto BOSSI – Institut Gustave Roussy Villejuif Résultats fonctionnels de la curiethérapie VS radiothérapie externe VS chirurgie des cancers de prostate

RP, EBRT or brachytherapy? Are there differences in efficacy? no randomised controlled trials (RCTs) comparing radical prostatectomy (RP) external beam radiation therapy (EBRT) brachytherapy (BT) virtually impossible to state that one therapy is clearly superior over another... Heidenreich A et al. Eur Urol 2011;59:61-71; Wilkins A et al. Nat Rev Clin Oncol 2010;7:583-9

…du fait de léquivalence defficacité des différents traitements locaux du cancer de la prostate avec plus de 15 ans de recul, la toxicité des traitements et la qualité de vie post thérapeutique apparaissent comme étant des éléments décisionnels majeurs en faveur dun traitement plutôt que dun autre.

Sanda, NEJM, 2008

1201 pts, from 2003 to 2006 (+ 625 partners) Nine University affiliated Hospitals T1 – T2 Prostate Cancer: RP (+/- robot), 603 EBRT (+/- HT), 292 BT (+/- EBRT), 306 Median follow-up: 30 months Expanded Prostate Cancer Index, EPIC-26 Service Satisfaction Scale for Cancer Care, SCA (+ Partners) Sanda, NEJM, 2008

AGE COMORBIDITIES Sanda, NEJM, 2008

EBRTPRBT PSA GLEASON bps STAGE Sanda, NEJM, 2008

Sexual Score Urinary Incontinence Urinary Irritation and Obstructive Score Bowel and Rectal Score Vitality and Hormonal Score Sanda, NEJM, 2008

Sexual score

Prostatectomy Radiotherapy Brachytherapy Urinary Incontinence Sanda, NEJM, 2008

Brachytherapy Radiotherapy Prostatectomy Sanda, NEJM, 2008 Urinary Irritation Obstruction Score

Prostatectomy Radiotherapy Brachytherapy Sanda, NEJM, 2008 Bowel Rectal Score

Prostatectomy Radiotherapy Brachytherapy Vitality or Hormonal Score Sanda, NEJM, 2008

prospective, non-randomised study; median follow-up (FU) 2.5 yr Adapted from: Sanda MG et al. NEJM 2008 RP, EBRT or brachytherapy? Are there differences in Toxicity / Quality of Life? Urinary incontinenceBowel/rectal function

Quality of Life and Satisfaction with the Outcome …symptoms related to sexual function, vitality and urinary function were independently associated with outcome satisfaction among patients. Sanda, NEJM, 2008

Quality of Life DomainTreatment GroupIndependent variable Sexual FunctionProstatectomy Age / PSA / Nerve Sparing Radiotherapy Age / Prostate Size / Neoadjuvant Hormones BrachytherapyAge / PSA Vitality Hormone Function ProstatectomyObesity Radiotherapy Obesity / Prostate Size / Neoadjuvant HT Brachytherapy Age / Prostate Size / Neoadjuvant Hormones Urinary Irritation Obstruction ProstatectomyProstate Size Radiotherapy Prostate Size / Neoadjuvant HT Brachytherapy Prostate Size / PSA / Neoadjuvant HT Adapted from: Sanda MG et al. NEJM 2008

Merrick, J Urol, 2003

TRIFECTA after RP » Single-centre, single-surgeon study in 1,005 men with localised PCa undergoing RP » Mean age 59 yrs; mean FU 54 mo » Trifecta: recurrence-free, potent and continent »At 2 yrs: 63.5%; at 5 yrs: 60.5% » Age, pathologic Gleason score, pathologic stage, prostate specimen weight and nerve sparing independent predictors of achieving trifecta after RP Trifecta is affected by age, pathologic Gleason score, nerve sparing, resected prostate weight and pathologic stage but not by clinical stage or BMI. This may aid in counseling pts undergoing RP AUA#1748: Antebi E. J Urol 2010:183(4 Suppl):e675(abs.1748)

Valdagni, Cancer, 2009

Valdagni, IJROBP, 2009

Valdagni, Cancer, 2009