Active surveillance for prostate cancer: comparison between incidental tumors vs. tumors diagnosed at prostate biopsies.

Biopsy Humans Male Prostate / diagnostic imaging Prostatic Neoplasms / pathology Retrospective Studies Watchful Waiting
Active surveillance Active surveillance discontinuation Incidental prostate cancer Prostate biopsy Upgrading

Journal

World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716

Informations de publication

Date de publication:
Feb 2022
Historique:
received: 26 07 2021
accepted: 09 10 2021
pubmed: 24 10 2021
medline: 17 3 2022
entrez: 23 10 2021
Statut: ppublish

Résumé

To test discontinuation rates during Active Surveillance (AS) in patients diagnosed with incidental prostate cancers (IPCa) vs. tumors diagnosed at prostate biopsies (BxPCa). 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). 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. 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.

Identifiants

DOI: 10.1007/s00345-021-03864-6 PMID: 34687344
pubmed: 34687344
doi: 10.1007/s00345-021-03864-6
pii: 10.1007/s00345-021-03864-6
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

443-451

Informations de copyright

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Références

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Auteurs

Stefano Luzzago (S)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy. stefanoluzzago@gmail.com.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy. stefanoluzzago@gmail.com.
ORCID: 0000-0002-9373-1413

Mattia Luca Piccinelli (ML)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Università degli Studi di Milano, Milan, Italy.

Giulia Marvaso (G)

Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.

Ekaterina Laukhtina (E)

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Department of Urology, Medical University of Vienna, Vienna, Austria.

Noriyoshi Miura (N)

Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan.

Victor M Schuettfort (VM)

Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.

Keiichiro Mori (K)

Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.

Abdulmajeed Aydh (A)

Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, King Faisal Medical City, Abha, Saudi Arabia.

Matteo Ferro (M)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.

Francesco A Mistretta (FA)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.

Nicola Fusco (N)

Department of Pathology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.

Giuseppe Petralia (G)

Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.

Barbara A Jereczek-Fossa (BA)

Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.

Shahrokh F Shariat (SF)

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Research Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
European Association of Urology Research Foundation, Arnhem, The Netherlands.

Pierre I Karakiewicz (PI)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.

Ottavio de Cobelli (O)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.

Gennaro Musi (G)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.

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Classifications MeSH

questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Active surveillance for prostate cancer:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Active surveillance for prostate cancer:...
questionsmedicales.fr › Tissus › Glandes exocrines › Prostate › Active surveillance for prostate cancer:...
questionsmedicales.fr › Maladies urogénitales › Tumeurs de l'appareil urogénital › Tumeurs de l'appareil génital mâle › Tumeurs de la prostate › Active surveillance for prostate cancer:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Active surveillance for prostate cancer:...
questionsmedicales.fr › Administration des services de santé › Observation (surveillance clinique) › Active surveillance for prostate cancer:...