Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy for Prostate Cancer: Less Cost at the Expense of More Genitourinary Toxicity Is a Concerning But Testable Hypothesis
Menée à partir des données de la base Medicare portant sur 4 005 patients atteints d'un cancer de la prostate traité entre 2008 et 2011 (âge ≥ 66 ans), cette étude compare la toxicité et le coût d'une radiothérapie corporelle stéréotaxique et d'une radiothérapie avec modulation d'intensité
While randomized controlled trials (RCTs) show that prostate-specific antigen (PSA) –based screening reduces death from prostate cancer (PC and this effect appears to be more pronounced in younger and presumably healthier men (number needed to treat of 12 at a median follow-up of 14 years), the US Preventative Task Force has concluded that screening for PC with PSA does more harm than good. Why ? While it has been suggested in one RCT (ProstateCancer Intervention Versus Observation Trial [PIVOT]) after a median follow-up of 10 years that treatment of low-riskPC, which is detected more often with PSA screening, does not lead to a reduction in death from PC, the treatment effect for all men in the study approached significance (P.09) in reducing death from PC. This was observed despite being underpowered (designed to accrue 2,000 but accrued only 731 and enrolling men of less than average health based on a comparative SEER program study. Therefore, should these results at a 10-year median follow-up be used to decide on treatment for
healthy men who seremaining life expectancy is greater than 10 years? Probably not, yet this data has been used to deter PSA screening and has prompted active surveillance in men diagnosed with low-risk PC who are healthier than men in PIVOT...
Journal of Clinical Oncology , éditorial en libre accès, 2014