Mattia Luca Piccinelli1,2, Stefano Luzzago3,4, Giulia Marvaso5, Ekaterina Laukhtina6,7, Noriyoshi Miura7,8, Victor M Schuettfort7,9, Keiichiro Mori7,10, Abdulmajeed Aydh7,11, Matteo Ferro1, Francesco A Mistretta1, Nicola Fusco12,13, Giuseppe Petralia14,13, Barbara A Jereczek-Fossa5,13, Shahrokh F Shariat6,7,15,16,17,18,19,20, Pierre I Karakiewicz21, Ottavio de Cobelli1,13, Gennaro Musi1,13. 1. Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy. 2. Università degli Studi di Milano, Milan, Italy. 3. Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy. stefanoluzzago@gmail.com. 4. Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy. stefanoluzzago@gmail.com. 5. Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy. 6. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. 7. Department of Urology, Medical University of Vienna, Vienna, Austria. 8. Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan. 9. Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany. 10. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. 11. Department of Urology, King Faisal Medical City, Abha, Saudi Arabia. 12. Department of Pathology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy. 13. Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy. 14. Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy. 15. Research Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan. 16. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 17. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 18. Department of Urology, Weill Cornell Medical College, New York, NY, USA. 19. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 20. European Association of Urology Research Foundation, Arnhem, The Netherlands. 21. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Abstract
PURPOSE: To test discontinuation rates during Active Surveillance (AS) in patients diagnosed with incidental prostate cancers (IPCa) vs. tumors diagnosed at prostate biopsies (BxPCa). METHODS: Retrospective single center analysis of 961 vs. 121 BxPCa vs. IPCa patients (2008-2020). Kaplan-Meier plots and multivariable Cox regression models tested four different outcomes: (1) any-cause discontinuation; (2) discontinuation due to ISUP GG upgrading; (3) biopsy discontinuation due to ISUP GG upgrading or > 3 positive cores; (4) biopsy discontinuation or suspicious extraprostatic extension at surveillance mpMRI. Then, multivariable logistic regression models tested rates of clinically significant PCa (csPCa) (ISUP GG ≥ 3 or pT ≥ 3a or pN1) after radical prostatectomy (RP). RESULTS: Median time follow-up was 35 (19-64) months. IPCa patients were at lower risk of any-cause (3-year survival: 79.3 vs. 66%; HR: 0.5, p = 0.001) and biopsy/MRI AS discontinuation (3-year survival: 82.3 vs. 72.7%; HR: 0.5, p = 0.001), compared to BxPCa patients. Conversely, IPCa patients exhibited same rates of biopsy discontinuation and ISUP GG upgrading over time, relative to BxPCa. In multivariable logistic regression models, IPCa patients were associated with higher rates of csPCa at RP (OR: 1.4, p = 0.03), relative to their BxPCa counterparts. CONCLUSION: AS represents a safe management strategy for IPCa. Compared to BxPCa, IPCa patients are less prone to experience any-cause and biopsy/MRI AS discontinuation. However, the two mentioned groups present similar rates of biopsy discontinuation and ISUP GG upgrading over time. In consequence, tailored AS protocols with scheduled repeated surveillance biopsies should be offered to all newly diagnosed IPCa patients.
PURPOSE: To test discontinuation rates during Active Surveillance (AS) in patients diagnosed with incidental prostate cancers (IPCa) vs. tumors diagnosed at prostate biopsies (BxPCa). METHODS: Retrospective single center analysis of 961 vs. 121 BxPCa vs. IPCa patients (2008-2020). Kaplan-Meier plots and multivariable Cox regression models tested four different outcomes: (1) any-cause discontinuation; (2) discontinuation due to ISUP GG upgrading; (3) biopsy discontinuation due to ISUP GG upgrading or > 3 positive cores; (4) biopsy discontinuation or suspicious extraprostatic extension at surveillance mpMRI. Then, multivariable logistic regression models tested rates of clinically significant PCa (csPCa) (ISUP GG ≥ 3 or pT ≥ 3a or pN1) after radical prostatectomy (RP). RESULTS: Median time follow-up was 35 (19-64) months. IPCa patients were at lower risk of any-cause (3-year survival: 79.3 vs. 66%; HR: 0.5, p = 0.001) and biopsy/MRI AS discontinuation (3-year survival: 82.3 vs. 72.7%; HR: 0.5, p = 0.001), compared to BxPCa patients. Conversely, IPCa patients exhibited same rates of biopsy discontinuation and ISUP GG upgrading over time, relative to BxPCa. In multivariable logistic regression models, IPCa patients were associated with higher rates of csPCa at RP (OR: 1.4, p = 0.03), relative to their BxPCa counterparts. CONCLUSION: AS represents a safe management strategy for IPCa. Compared to BxPCa, IPCa patients are less prone to experience any-cause and biopsy/MRI AS discontinuation. However, the two mentioned groups present similar rates of biopsy discontinuation and ISUP GG upgrading over time. In consequence, tailored AS protocols with scheduled repeated surveillance biopsies should be offered to all newly diagnosed IPCa patients.
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