Roderick van den Bergh1, Giorgio Gandaglia2, Derya Tilki3, Hendrik Borgmann4, Piet Ost5, Christian Surcel6, Massimo Valerio7, Prasanna Sooriakumaran8, Laurent Salomon9, Alberto Briganti2, Markus Graefen3, Henk van der Poel10, Alexandre de la Taille11, Francesco Montorsi2, Guillaume Ploussard11. 1. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: roodvdb@hotmail.com. 2. Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 3. Department of Urology, Martini-Klinik Prostate Cancer Center and University Hospital, Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany. 5. Department of Radiotherapy, Ghent University Hospital, Belgium. 6. Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania. 7. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 8. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. 9. Henri Mondor Hospital, APHP, Créteil, France. 10. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 11. Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopole, Saint Jean Languedoc Hospital, Toulouse, France.
Abstract
BACKGROUND: Active surveillance (AS) has been increasingly proposed as the preferential initial management strategy for low-risk prostate cancer (PC), while in high-risk PC the indication for surgery has widened. OBJECTIVE: To evaluate the development of risk group distribution of patients undergoing radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS: Retrospective database review of combined RP databases (2000-2015) of four large European centers (Créteil, Paris; San Rafaele, Milan; Martini Klinik, Hamburg; NKI, AvL, Amsterdam). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinical and pathological characteristics per year of surgery. Eligibility for AS was defined according to Prostate Cancer Research International Active Surveillance criteria: cT≤2c, cN0/X, cM0/X, PSA ≤10ng/ml, prostate-specific antigen density <0.2ng/ml/ml, one to two positive biopsies, and Gleason score ≤6, high-risk disease as: cT≥3, c N1, cM1, PSA >20ng/ml, and/or Gleason ≥8. RESULTS AND LIMITATIONS: In total, 28572 patients had complete clinical and 24790 complete pathological data available. The absolute number of RPs increased: 401, 975, 2344, and 2504 in 2000, 2005, 2010, and 2015, respectively. The proportion of cases considered suitable for AS decreased: 31%, 32%, 18%, and 5%, while the cases considered high risk increased: 10%, 8%, 16%, and 30%. The percentage of patients having only localized Gleason 6 disease after RP decreased: 46%, 34%, 14%, and 8% for all patients (p<0.01), as well as for AS-suitable patients: 70%, 54%, 41%, and 38% (p<0.01). Comparisons between centers were outside the scope of this article. Developments in diagnostics may have impacted on results. CONCLUSIONS: This European analysis confirmed the risk profile of patients undergoing RP shifting away of the most favorable disease spectrum. Patients with PC clinically considered suitable for AS and men having only localized Gleason 6 disease pathologically comprised a decreasing share of all RP performed. High-risk disease comprised an increasing share of all RPs. PATIENT SUMMARY: The databases of four large European centers of prostate cancer surgery were analyzed. In recent years, the risk profile of patients shifted away of low-risk cancer, while high-risk cancer comprised a larger part of cases. This confirms the introduction of active surveillance for low-risk prostate cancer and increase in potentially curative options for high-risk disease.
BACKGROUND: Active surveillance (AS) has been increasingly proposed as the preferential initial management strategy for low-risk prostate cancer (PC), while in high-risk PC the indication for surgery has widened. OBJECTIVE: To evaluate the development of risk group distribution of patients undergoing radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS: Retrospective database review of combined RP databases (2000-2015) of four large European centers (Créteil, Paris; San Rafaele, Milan; Martini Klinik, Hamburg; NKI, AvL, Amsterdam). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinical and pathological characteristics per year of surgery. Eligibility for AS was defined according to Prostate Cancer Research International Active Surveillance criteria: cT≤2c, cN0/X, cM0/X, PSA ≤10ng/ml, prostate-specific antigen density <0.2ng/ml/ml, one to two positive biopsies, and Gleason score ≤6, high-risk disease as: cT≥3, c N1, cM1, PSA >20ng/ml, and/or Gleason ≥8. RESULTS AND LIMITATIONS: In total, 28572 patients had complete clinical and 24790 complete pathological data available. The absolute number of RPs increased: 401, 975, 2344, and 2504 in 2000, 2005, 2010, and 2015, respectively. The proportion of cases considered suitable for AS decreased: 31%, 32%, 18%, and 5%, while the cases considered high risk increased: 10%, 8%, 16%, and 30%. The percentage of patients having only localized Gleason 6 disease after RP decreased: 46%, 34%, 14%, and 8% for all patients (p<0.01), as well as for AS-suitable patients: 70%, 54%, 41%, and 38% (p<0.01). Comparisons between centers were outside the scope of this article. Developments in diagnostics may have impacted on results. CONCLUSIONS: This European analysis confirmed the risk profile of patients undergoing RP shifting away of the most favorable disease spectrum. Patients with PC clinically considered suitable for AS and men having only localized Gleason 6 disease pathologically comprised a decreasing share of all RP performed. High-risk disease comprised an increasing share of all RPs. PATIENT SUMMARY: The databases of four large European centers of prostate cancer surgery were analyzed. In recent years, the risk profile of patients shifted away of low-risk cancer, while high-risk cancer comprised a larger part of cases. This confirms the introduction of active surveillance for low-risk prostate cancer and increase in potentially curative options for high-risk disease.
Authors: Margaretha A van der Slot; Michael A den Bakker; Sjoerd Klaver; Mike Kliffen; Martijn B Busstra; John B W Rietbergen; Melanie Gan; Karen E Hamoen; Leo M Budel; Natascha N T Goemaere; Chris H Bangma; Jozien Helleman; Monique J Roobol; Geert J L H van Leenders Journal: Histopathology Date: 2020-09-03 Impact factor: 5.087
Authors: Shivam M Kharod; Catherine E Mercado; Christopher G Morris; Curtis M Bryant; Nancy P Mendenhall; William M Mendenhall; R Charles Nichols; Bradford S Hoppe; Xiaoying Liang; Zhong Su; Zuofeng Li; Randal H Henderson Journal: Int J Part Ther Date: 2021-03-12
Authors: Benedikt Hoeh; Felix Preisser; Philipp Mandel; Mike Wenzel; Clara Humke; Maria-Noemi Welte; Matthias Müller; Jens Köllermann; Peter Wild; Luis A Kluth; Frederik C Roos; Felix K H Chun; Andreas Becker Journal: Front Surg Date: 2021-03-01