Trends in Radical Prostatectomy Risk Group Distribution in a European Multicenter Analysis of 28 572 Patients: Towards Tailored Treatment.

Détails

ID Serval
serval:BIB_30F7D20D669D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Trends in Radical Prostatectomy Risk Group Distribution in a European Multicenter Analysis of 28 572 Patients: Towards Tailored Treatment.
Périodique
European urology focus
Auteur⸱e⸱s
van den Bergh R., Gandaglia G., Tilki D., Borgmann H., Ost P., Surcel C., Valerio M., Sooriakumaran P., Salomon L., Briganti A., Graefen M., van der Poel H., de la Taille A., Montorsi F., Ploussard G.
Collaborateur⸱rice⸱s
European Association of Urology Young Academic Urologists Working Party on Prostate Cancer (EAU-YAUWP)
ISSN
2405-4569 (Electronic)
ISSN-L
2405-4569
Statut éditorial
Publié
Date de publication
03/2019
Peer-reviewed
Oui
Volume
5
Numéro
2
Pages
171-178
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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.
To evaluate the development of risk group distribution of patients undergoing radical prostatectomy (RP).
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).
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.
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.
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.
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.
Mots-clé
Active surveillance, Prostate cancer, Radical prostatectomy, Risk classification, Treatment trends
Pubmed
Web of science
Création de la notice
06/09/2017 17:09
Dernière modification de la notice
10/10/2019 6:10
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