Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy.
The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND).
The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies.
PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
World journal of urology. 2020 Aug 01 [Epub ahead of print]
Mauro Gacci, Walter Artibani, Pierfrancesco Bassi, Filippo Bertoni, Sergio Bracarda, Alberto Briganti, Giorgio Carmignani, Luca Carmignani, Giario Conti, Renzo Corvò, Cosimo De Nunzio, Ferdinando Fusco, Pierpaolo Graziotti, Isabella Greco, Stefania Maggi, Stefano Maria Magrini, Vincenzo Mirone, Rodolfo Montironi, Giuseppe Morgia, Giovanni Muto, Marianna Noale, Stefano Pecoraro, Angelo Porreca, Umberto Ricardi, Elvio Russi, Giorgio Russo, Andrea Salonia, Alchiede Simonato, Sergio Serni, Davide Tomasini, Andrea Tubaro, Vittorina Zagonel, Gaetano Crepaldi, MIRROR-SIU/LUNA Study Group and the Pros-IT CNR Study Group
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