Aim of the study Over-diagnosis and over-treatment are potential side effects of PSA screening policies for prostate cancer (PCa). Active surveillance (AS) has evolved as an alternative to active treatment in case of low- risk PCa, to minimize side effects. Several protocols of AS has been proposed, based on standardized clinical parameters such as Prostate Cancer Research International Active Survelliance (PRIAS) criteria. Nevertheless in patients in AS the real pathological stage remains unknown. The aim of our study is to retrospectively make out the pathological stage in a multicenter cohort of patients who had undergone radical prostatectomy (RP) meeting the preoperative PRIAS criteria. Materials and methods Out of 923 patients recruited for minimally invasive RP between December 2009 and February 2013 in 5 Italian urological centers, 144 (15.6%) would have met the PRIAS criteria modified (clinical stage T1c/T2, PSA < or =6). The pathological features of these low risk patients have been investigated. Results The preoperative patients’ characteristics are shown in table 1. Out of 144 patients included, 89 (61.8%) underwent laparoscopic RP and 55 (38.2%) robot-assisted RP. At pathological evaluation, Gleason score upgrade was reported in 40.9% of patients; 47 (32.6%), 11 (7.6%), 1 (0.7%) patients showed RP Gleason sum 7, 8 and 9, respectively. 15 (10.4%) and 4 (2.7%) patients had T3a and T3b pathological stage respectively. One patient showed lymph node invasion. 31 patients (20.9%) had positive surgical margins, of these 11 (35.5%) were multifocal. The positive surgical margin rate for pT2 and pT3 disease was 16.8% and 52.6%, respectively. Discussion AS is a well established standard approach for low risk localized prostate cancer. However, probably due to the poor reproducibility of the clinical tools, significant diseases can be under-diagnosed or missed. Analysing the pathological features on definitive specimens, some of these low risk patients demonstrated a migration in to intermediate or high risk groups according to D’Amico classification. Despite the preoperative estimated low risk of these patients, the rate of positive surgical margins was not negligible, particularly in pT3 stage. Conclusions Notwithstanding some preoperative criteria can define patients affected by PCa as low risk patients, at the pathological evaluation some of these revealed intermediate-high risk disease. So, based on our data, patients candidated to AS should be carefully counseled on possible disease understaging.

PATHOLOGICAL OUTCOMES IN PATIENTS CANDIDABLE FOR ACTIVE SURVEILLANCE TREATED WITH RADICAL PROSTATECTOMY. ARE THEY REALLY LOW RISK PATIENTS? / Minervini, A.; De Lorenzis, E.; Grasso, A.; Conti, A.; Falsaperla, M.; Porreca, A.; Cindolo, L.; Celia, A.; Antonelli, A.; Parma, P.; Crivellaro, S.; Zaramella, S.; Di Domenico, A.; Del Biondo, D.; Bove, P.; Gacci, M.; Lanciotti, M.; Serni, S.; Rocco, B.. - STAMPA. - Unico:(2013), pp. 168-168. (Intervento presentato al convegno 86° Congresso Nazionale SIU).

PATHOLOGICAL OUTCOMES IN PATIENTS CANDIDABLE FOR ACTIVE SURVEILLANCE TREATED WITH RADICAL PROSTATECTOMY. ARE THEY REALLY LOW RISK PATIENTS?

MINERVINI, ANDREA;GACCI, MAURO;LANCIOTTI, MICHELE;SERNI, SERGIO;
2013

Abstract

Aim of the study Over-diagnosis and over-treatment are potential side effects of PSA screening policies for prostate cancer (PCa). Active surveillance (AS) has evolved as an alternative to active treatment in case of low- risk PCa, to minimize side effects. Several protocols of AS has been proposed, based on standardized clinical parameters such as Prostate Cancer Research International Active Survelliance (PRIAS) criteria. Nevertheless in patients in AS the real pathological stage remains unknown. The aim of our study is to retrospectively make out the pathological stage in a multicenter cohort of patients who had undergone radical prostatectomy (RP) meeting the preoperative PRIAS criteria. Materials and methods Out of 923 patients recruited for minimally invasive RP between December 2009 and February 2013 in 5 Italian urological centers, 144 (15.6%) would have met the PRIAS criteria modified (clinical stage T1c/T2, PSA < or =6). The pathological features of these low risk patients have been investigated. Results The preoperative patients’ characteristics are shown in table 1. Out of 144 patients included, 89 (61.8%) underwent laparoscopic RP and 55 (38.2%) robot-assisted RP. At pathological evaluation, Gleason score upgrade was reported in 40.9% of patients; 47 (32.6%), 11 (7.6%), 1 (0.7%) patients showed RP Gleason sum 7, 8 and 9, respectively. 15 (10.4%) and 4 (2.7%) patients had T3a and T3b pathological stage respectively. One patient showed lymph node invasion. 31 patients (20.9%) had positive surgical margins, of these 11 (35.5%) were multifocal. The positive surgical margin rate for pT2 and pT3 disease was 16.8% and 52.6%, respectively. Discussion AS is a well established standard approach for low risk localized prostate cancer. However, probably due to the poor reproducibility of the clinical tools, significant diseases can be under-diagnosed or missed. Analysing the pathological features on definitive specimens, some of these low risk patients demonstrated a migration in to intermediate or high risk groups according to D’Amico classification. Despite the preoperative estimated low risk of these patients, the rate of positive surgical margins was not negligible, particularly in pT3 stage. Conclusions Notwithstanding some preoperative criteria can define patients affected by PCa as low risk patients, at the pathological evaluation some of these revealed intermediate-high risk disease. So, based on our data, patients candidated to AS should be carefully counseled on possible disease understaging.
2013
86° Congresso Nazionale SIU. Libro degli abstracts
86° Congresso Nazionale SIU
Minervini, A.; De Lorenzis, E.; Grasso, A.; Conti, A.; Falsaperla, M.; Porreca, A.; Cindolo, L.; Celia, A.; Antonelli, A.; Parma, P.; Crivellaro, S.; Zaramella, S.; Di Domenico, A.; Del Biondo, D.; Bove, P.; Gacci, M.; Lanciotti, M.; Serni, S.; Rocco, B.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1056485
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