Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 24

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
44 Active surveillance, an alternative treatment option
for early prostate cancer: Short-term results of the
Finnish arm of the PRIAS study
H Vasarainen, A Rannikko
Department ofUrology, Helsinki University Central Hospital, Finland
hanna.vasarainen@hus.fi
Introduction: Active surveillance has emerged as an altemative
treatment option for men with localized, small and well-
differentiated prostate cancer instead of immediate curative
treatment. Active surveillance aims at avoiding overtreatment
and thereby minimizing the treatment related side-effects.
PRIAS study (Prostate Cancer Research International: Active
Surveillance) is a prospective intemational multicenter study
based on strict inclusion and exclusion criteria and follow-up
scheme (1,2). Here we report our initial findings in the Finnish
arm of the study.
Methods: The PRIAS study started internationally in December
2006 and 698 patients were recruited by the time of analysis; 88
(13%) of them from Finland. Inclusion criteria are: histologically
proven prostate carcinoma in 1 or 2 biopsy cores, Gleason score
3+3=6, clinical stage Tlc or T2, PSA level slO, PSA density s0.2
and no previous treatment for prostate cancer. Patients have to
be fit for curative treatment.
Results: Mean age at diagnosis (of our 88 patients) was 63 years
(range 45-77), PSA 5.3 ng/ml (1,0-9,5), free PSA 18% (3-68) and
mean prostate volume was 43 cc (15-100). In 85 (97%) of these
patients 12 biopsy cores were taken at the time of diagnosis and
64 (73%) had only one positive biopsy. Initially 85 (97%) had
Gleason score 6 (3+3) adenocarcinoma in biopsies.
Median follow-up was 13 months (1-25). 77 (88%) men were still
on active surveillance by the time of analysis and 11 (13%) had
been treated curatively. Median time of 15 months (7-26) was
observed for patients changing treatment. Reason for changing
treatment was protocol based in 10/11 cases: five (46%) patients
because of more than 2 positive biopsy cores in rebiopsies, three
(27%) because of PSA-DT <3 years, one (9%) because of Gleason
score >6 in rebiopsies. One patient had >2 positive rebiopsy
cores and Gleason upgrading (>6). Only one patient wanted
to stop active surveillance based on anxiety or request. Active
therapies elected by men coming off surveillance were radical
prostatectomy in four patients, external beam radiation therapy
in three and brachyterapy in two.
Conclusions: Active surveillance is an emerging treatment
modality in "low-risk" prostate cancer. However, there is
substantial lack of prospective data regarding this treatment.
PRIAS study is the largest prospective trial assessing active
surveillance and the preliminary data from the Finnish arm of
the study are encouraging.
After a short follow-up a strict adherence to the follow-up
protocol was observed and only one patient changed treatment
because of anxiety. Therefore surveillance related psychological
distress does not seem to be as common as suggested earlier (3).
Oncological results are awaited.
45 Anesthesia and prostate biopsy
R Zare
Drammen Hospital, Norway
zare@sabhf.no
Internal study was undertaken to assess: 1-Adequate anesthesia
for prostate biopsy. 2-To assess level of pain after the procedure.
3-To observe relation between age and the level of pain. 4-
Incidence of infection with and without invasive anesthesia
Methods and materials: 196 patients in 3 groups.-Group 1 (Gl)
No anesthesia (n=57)-Group 2 (G2) received lg paracetamol 1
hour before biopsy and xylocain gel 20 ml rectal 10 min before
biopsy + paracetamol lg x 3 on day 1 (n=69) -Group 3 (G3)
received xylocain inj. lOml periprostatic 5min before procedure
(n=70)-All patients received tbl. Ciproxin 500mg 1 hour before
and 2 tbl post procedure -Vas scale
Result: pain during procedure Result: pain post procedure
Groups Mean SD P.value Groups Mean SD P.value
G1=No anes 3.46 G1:G2=1.0 G1=No anes 1.6 G1:
(n=57) 2.33 (n=57) 1.88 G2=0.850
G2=paracet+gel 3.42 G1: G2=paracet+gel 1.3 G1:
(n=69) 2.63 G3=0.012 (n=69) 2.03 G3=0.995
G3=inj.xyl (n=70) 2.27 G2: G3=inj.xyl 1.54 G2:
1.93 G3=0.007 (n=70) 2.17 G3=0.910
F.test=0.003 F.test=0.739
Infection: Total = 4.1%G1+G2 =2.9 G3=8.6
Conclusion: No significant difference in level of pain was
observed between group 1 and group 2 during the procedure.
Lower level of pain in group 2 after the procedure but not
significant. Significant lower level of pain was observed during
the procedure in group 3. Significant lower pain in elderly
patient by regressionscoeff.= 0,049; p-value = 0,013. Significant
increase in risk for infection was observed in group 3 (invasive
anesthesia), but big confidence interval to odds ratio because of
low number of patient with infection.
46 Control of prostate cancer by salvage high intensity
focused ultrasound (HIFU) treatment
V Berge, E Baco, SJ Karlsen
Oslo Urological University Clinic, Aker University Hospital, Oslo, Nonvay
viktbe@onlinc.no
Aim: To evaluate the efficacy and safety of HIFU salvage
therapy for patients with local relapse after extemal beam
radiation therapy (EBRT).
Material and methods: Between October 2006 and April 2008,
36 patients with recurrence after EBRT were treated with salvage
HIFU treatment. There is adequate follow-up of 23 of these
patients. Mean age 66.5 ± 7.4 years. Mean PSA at diagnosis (pre-
EBRT) was 23.3 ± 18.6 ng/ml.
24 LÆKNAblaðið 2009/95