OBJECTIVE: To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series. PATIENTS AND METHODS: From 1080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level <10 ng/mL, clinical stage < or =T2a and biopsy Gleason score < or =6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of 'insignificant' disease were assessed. RESULTS: The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1-9) ng/mL; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score > or =7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%) and biochemical failure occurred in six patients (1.1%) with a median follow-up of 28 months. CONCLUSION: In this contemporary UK cohort of patients with apparently low- or favourable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harbouring more significant disease.
OBJECTIVE: To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series. PATIENTS AND METHODS: From 1080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level <10 ng/mL, clinical stage < or =T2a and biopsy Gleason score < or =6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of 'insignificant' disease were assessed. RESULTS: The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1-9) ng/mL; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score > or =7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%) and biochemical failure occurred in six patients (1.1%) with a median follow-up of 28 months. CONCLUSION: In this contemporary UK cohort of patients with apparently low- or favourable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harbouring more significant disease.
Authors: G I Russo; T Castelli; V Favilla; G Reale; D Urzì; S Privitera; E Fragalà; S Cimino; G Morgia Journal: Prostate Cancer Prostatic Dis Date: 2015-06-02 Impact factor: 5.554
Authors: Julia H Hayes; Daniel A Ollendorf; Steven D Pearson; Michael J Barry; Philip W Kantoff; Susan T Stewart; Vibha Bhatnagar; Christopher J Sweeney; James E Stahl; Pamela M McMahon Journal: JAMA Date: 2010-12-01 Impact factor: 56.272
Authors: Dong Il Kang; Thomas L Jang; Jeongyun Jeong; Eun Young Choi; Kelly Johnson; Dong Hyeon Lee; Wun-Jae Kim; Isaac Yi Kim Journal: Asian J Androl Date: 2011-07-25 Impact factor: 3.285
Authors: Francesco Cantiello; Giorgio Ivan Russo; Antonio Cicione; Matteo Ferro; Sebastiano Cimino; Vincenzo Favilla; Sisto Perdonà; Ottavio De Cobelli; Carlo Magno; Giuseppe Morgia; Rocco Damiano Journal: World J Urol Date: 2015-07-21 Impact factor: 4.226