Radical Prostatectomy For Low-risk Prostate Cancer Research Articles

Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance

BackgroundMetabolic syndrome (MetS) is considered a potential risk factor for adverse outcomes after radical prostatectomy (RP). Furthermore, studies about the effect of MetS on low-risk prostate cancer (PCa) and its implications in active surveillance (AS) are limited. ObjectiveTo investigate the role of MetS (using International Diabetes Federation–American Heart Association/National Heart, Lung, and Blood Institute criteria) on perioperative and oncological outcomes after RP in low-risk PCa and in a subgroup potentially eligible for AS. Design, setting, and participantsA total of 3662 patients treated with RP for low-risk PCa and further stratified as very low risk (VLR) PCa—prostate-specific antigen density of ≤0.15ng/ml/cm3, ≤2 cores involved, and no core with >50% cancer involvement—at a tertiary referral hospital were identified. Outcome measurements and statistical analysisOutcomes analyzed were pathological outcomes, perioperative complications, biochemical failure (BCF), and overall survival. Pathological outcomes and complications were analyzed with logistic regression models. Kaplan–Meier curves and Cox proportional hazards models were used to analyze survival outcomes. Results and limitationsIn univariate/multivariate analyses, MetS was associated with upgrading and positive surgical margins in the entire cohort, upgrading only in the VLR group. In Kaplan–Meier analysis, MetS patients had a higher rate of overall death (p<0.0001) and BCF (p=0.03) for MetS patients. In the VLR group, no differences were found for BCF (p=0.064). Further, in Cox proportional hazards models, MetS was not associated with BCF (hazard ratio=1.23; 95% confidence interval [CI]=0.95–1.60, p=0.12). MetS patients had a higher rate of complications compared with non-MetS patients (23.7% vs 19.7%; p=0.01). In multivariate analysis, MetS was associated with a higher rate of complications (odds ratio=1.24, 95% CI=1.04–1.49, p=0.018) but did not impact the rate of major ones. This study is limited by its retrospective design. ConclusionsIn low-risk PCa treated with RP but potentially eligible for AS, MetS impacted perioperative and pathological outcomes, suggesting further study of MetS in patients undergoing AS. Patient summaryMetabolic syndrome negatively impacts perioperative and pathological outcomes in low-risk prostate cancer patients treated with radical prostatectomy but potentially eligible for active surveillance, in a large American single-center cohort. These findings suggest the need for a more cautious approach to low-risk prostate cancer in patients with metabolic syndrome.

Temporal Trends in Clinical and Pathological Characteristics for Men Undergoing Radical Prostatectomy Between 1995 and 2013 at Rigshospitalet, Copenhagen, Denmark, and Stanford University Hospital, United States.

To analyze how prostate-specific antigen (PSA) screening and practice patterns has affected trends in tumor characteristics in men undergoing radical prostatectomy (RP) in the United States and Denmark. Unlike in the United States, PSA screening has not been recommended in Denmark. We performed an observational register study using pre- and postoperative data on 2168 Danish patients from Rigshospitalet, Copenhagen, Denmark, and 2236 patients from Stanford University Hospital, Stanford, CA, who underwent RP between 1995 and 2013. Patients were stratified according to Cancer of the Prostate Risk Assessment-Postsurgical (CAPRA-S) risk groups and D'Amico risk classification and were clustered into 4 time periods (1995-1999, 2000-2004, 2005-2009, and 2010-2013). Temporal trends in the proportions of patients of a given variable at the 2 institutions were evaluated with Cochran-Armitage test for trends and chi-square testing. A total of 4404 patients were included. Temporal changes in preoperative PSA, age, grade, and stage was found in both cohorts. Median preoperative PSA declined in both cohorts, while median age increased, with the Danish cohort showing the greatest changes in both PSA and age. In both cohorts, there was a trend for higher-risk preoperative features before RP over time. In 2010-2013, 27.7% and 21.8% of the patients were in the D'Amico high-risk group at Copenhagen and Stanford, respectively. Despite recommendation against PSA screening in Denmark, Danish men undergoing RP at Rigshospitalet to a considerable extent now resemble American men undergoing RP at Stanford. At both sites, there is continued trend to reduce the number of men undergoing RP for low-risk prostate cancer.

Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy.

This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP). We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study. The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p=0.004), capsular invasion (CI) (p=0.001), age (p=0.014), and tumor size (p=0.006). However, only CI was found to be significant in multivariate analysis (p=0.001). Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.