Mauro Gacci1, Walter Artibani2, Pierfrancesco Bassi3, Filippo Bertoni4, Sergio Bracarda5, Alberto Briganti6, Giorgio Carmignani7, Luca Carmignani8, Giario Conti9, Renzo Corvò10, Cosimo De Nunzio11, Ferdinando Fusco12, Pierpaolo Graziotti13, Isabella Greco14, Stefania Maggi15, Stefano Maria Magrini16, Vincenzo Mirone12, Rodolfo Montironi17, Giuseppe Morgia18, Giovanni Muto19, Marianna Noale15, Stefano Pecoraro20, Angelo Porreca21, Umberto Ricardi22, Elvio Russi23, Giorgio Russo18, Andrea Salonia24, Alchiede Simonato25, Sergio Serni14, Davide Tomasini16, Andrea Tubaro11, Vittorina Zagonel26, Gaetano Crepaldi15. 1. Department of Urological minimally invasive and Robotic Surgery and kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy. maurogacci@yahoo.it. 2. Urologic Clinic, Department of Oncological and Surgical Sciences, AOU Integrata and University of Verona, Verona, Italy. 3. Department of Urology, University of Rome La Cattolica, Rome, Italy. 4. AIRO-Italian Association for Radiation Oncology, Rome, Italy. 5. Department of Oncology, Santa Maria Hospital, Terni, Italy. 6. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy. 7. Department of Urology, University of Genoa, Genoa, Italy. 8. Department of Urology, San Donato Policlinic Hospital, Milan, Italy. 9. Department of Urology, Sant' Anna Hospital, Como, Italy. 10. Department of Radiation Oncology, AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy. 11. Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. 12. Department of Urology, University Federico II, Naples, Italy. 13. Department of Urology, San Giuseppe Hospital, Milan, Italy. 14. Department of Urological minimally invasive and Robotic Surgery and kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy. 15. Aging Branch, National Research Council (CNR), Neuroscience Institute, Padua, Italy. 16. Radiation Oncology Unit, University of Brescia and Spedali Civili Hospital, Brescia, Italy. 17. Section of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy. 18. Department of Urology, University of Catania, Catania, Italy. 19. Department of Urology, Humanitas, Hospital Gradenigo, Turin, Italy. 20. Department of Nephrourology, Malzoni Center, Avellino, Italy. 21. Department of Urology, Abano Terme General Hospital, Padua, Italy. 22. Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy. 23. Radiation Unit, San Croce e Carle Hospital, Cuneo, Italy. 24. Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy. 25. Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy. 26. Medical Oncology Unit, Oncological Institute, Veneto IOV-IRCCS, Padua, Italy.
Abstract
PURPOSE: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. METHODS: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). RESULTS: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. CONCLUSIONS: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
PURPOSE: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. METHODS: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). RESULTS: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. CONCLUSIONS: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
Authors: Vincenzo Ficarra; Giacomo Novara; Walter Artibani; Andrea Cestari; Antonio Galfano; Markus Graefen; Giorgio Guazzoni; Bertrand Guillonneau; Mani Menon; Francesco Montorsi; Vipul Patel; Jens Rassweiler; Hendrik Van Poppel Journal: Eur Urol Date: 2009-01-25 Impact factor: 20.096
Authors: Axel Heidenreich; Gunnar Aus; Michel Bolla; Steven Joniau; Vsevolod B Matveev; Hans Peter Schmid; Filliberto Zattoni Journal: Eur Urol Date: 2007-09-19 Impact factor: 20.096
Authors: Johannes Bruendl; Clemens Rothbauer; Bernd Ludwig; Bernhard Dotzler; Christian Wolff; Sandra Reimann; Hendrik Borgmann; Maximilian Burger; Johannes Breyer Journal: Urol Int Date: 2018-03-07 Impact factor: 2.089
Authors: M Gacci; L Livi; F Paiar; B Detti; M S Litwin; R Bartoletti; G Giubilei; T Cai; M Mariani; M Carini Journal: Urology Date: 2005-08 Impact factor: 2.649
Authors: Ciro Imbimbo; Massimiliano Creta; Mauro Gacci; Alchiede Simonato; Paolo Gontero; Ottavio de Cobelli; Alberto Briganti; Vittorio Fulcoli; Giuseppe Martorana; Giulio Nicita; Vincenzo Mirone; Giorgio Carmignani Journal: J Sex Med Date: 2011-02-16 Impact factor: 3.802
Authors: Alchiede Simonato; Virginia Varca; Mauro Gacci; Paolo Gontero; Ottavio De Cobelli; Massimo Maffezzini; Roberto Salvioni; Marco Carini; Andrea Decensi; Vincenzo Mirone; Giorgio Carmignani Journal: Adv Urol Date: 2012-05-15
Authors: Jeffrey J Leow; Steven L Chang; Christian P Meyer; Ye Wang; Julian Hanske; Jesse D Sammon; Alexander P Cole; Mark A Preston; Prokar Dasgupta; Mani Menon; Benjamin I Chung; Quoc-Dien Trinh Journal: Eur Urol Date: 2016-02-11 Impact factor: 20.096