2. UroToday Home
  3. Recent Abstracts
  4. Urologic Oncology
  5. Prostate Cancer

Pros-IT CNR: An Italian Prostate Cancer Monitoring Project - Beyond the Abstract

Prostate cancer has become, in the last decades, the most frequently diagnosed cancer in the male population of Western countries; the data collected by the Italian Cancer Registers confirm this evidence also for 2020 (over 36,000 new diagnoses, representing 19% of all male cancers). Mortality rates are, on the other hand, decreasing: net survival 5 years after diagnosis reaches 92%.1 The increasing number of men with prostate cancer diagnoses and the rising life expectancies highlight the importance of evaluating the quality of life (QoL) among these patients. Several studies reported very interesting results about QoL of PCa patients,2–4 but the generalizability of these results may be limited across different populations, due to differences in measurement tools and reporting methods. Nonetheless, understanding the efficacy and harms of each treatment is important in patients’ counseling and shared decision-making process. Therefore, the “PROState cancer monitoring in Italy” project from the National Research Council (Pros-IT CNR) was designed, with the main aim to monitor QoL in PCa patients.5 Briefly, it is a longitudinal and observational study, involving 97 Urology, Radiation Oncology and Medical Oncology facilities located throughout Italy, enrolling a non-probability convenience sample of 1705 treatment-naïve patients with histologically confirmed PCa from September 2014 to September 2015. Patients were enrolled at PCa diagnosis (baseline) and were followed at 6 time-points after diagnosis (from 6 to 60 months from the diagnosis), evaluating treatments performed and QoL through the Short-Form Health Survey (SF-126) and the University of California Los Angeles-Prostate Cancer Index (Italian UCLA-PCI7,8).


Data from the Pros-IT study describing patients’ characteristics and QoL estimates at the PCa diagnosis were in line or even higher than that for the general population.9 The possible relationships between patients' characteristics at diagnosis and subsequent treatment patterns reported at the 6-month follow-up were evaluated using exploratory multiple correspondence analysis; these analyses uncovered substantial differences in ages, comorbidities, clinical and QoL features among patients in the various treatment groups.10 The determinants of receipt of treatment with curative intent among patients with localized PCa were then evaluated considering data from the first 12-month follow-up, demonstrating that in the Pros-IT cohort, the majority of these patients received radical prostatectomy, and this was associated with specific socio-demographic characteristics and QoL at diagnosis.11 Specific aspects of health-related QoL outcomes during the first 12-month follow-up were also compared considering different types of surgical approaches (open, laparoscopic, or robot-assisted).12 More generally, further analyses investigated the potential impact that radiation therapy, radical prostatectomy, and active surveillance may have on QoL outcomes measured up to 24-month from PCa diagnosis, demonstrating that although all the treatments were relatively well-tolerated over the 24-month period following PCa diagnosis, each had a different impact on QoL.13 The median waiting time for the first treatment after diagnosis was calculated for the Pros-IT cohort, and it was approximately equal to three months; its impact on QoL and oncological outcomes were also analyzed.14

Further studies and analyses are ongoing, based on data from more recent Pros-IT follow-ups, and the results could be useful in counseling the patients on the possible QoL impact of each treatment. From this point of view, the Pros-IT project, which strength lies in the multidisciplinary approach, has demonstrated that an appropriate discussion with a multidisciplinary team should be encouraged, with a patient-centered approach to treatment and shared decision making.

Written by: Noale Marianna, MSc, & Maggi Stefania, MD, National Research Council, Neuroscience Institute, Padua, Italy and the Pros-IT CNR study group

References:

  1. AIOM, AIRTUM S-I. I Numeri Del Cancro in Italia.; 2020.
  2. Koga H, Naito S, Ishiyama H, et al. Patient-reported health-related quality of life up to three years after the  treatment with permanent brachytherapy: Outcome of the large-scale, prospective longitudinal study in Japanese-Prostate Cancer Outcome Study by Permanent I-125 Seed Implantation . Brachytherapy. 2019;18(6):806-813. doi:10.1016/j.brachy.2019.06.006
  3. De Nunzio C, Pastore AL, Lombardo R, et al. The EORTC quality of life questionnaire predicts early and long-term incontinence in patients treated with robotic assisted radical prostatectomy: Analysis of a large single center cohort. Urol Oncol. 2019;37(12):1006-1013. doi:10.1016/j.urolonc.2019.06.024
  4. Mullins BT, Basak R, Broughman JR, Chen RC. Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population-based prospective cohort. Cancer. 2019;125(20):3657-3665. doi:10.1002/cncr.32288
  5. Noale M, Maggi S, Artibani W, et al. Pros-IT CNR: an Italian prostate cancer monitoring project. Aging Clin Exp Res. 2017;29(2). doi:10.1007/s40520-017-0735-6
  6. Apolone G, Mosconi P, Quattrociocchi L, Gianicolo EAL, Groth N WJ. Questionario Sullo Stato Di Salute Sf-12. Versione Italiana. Guerini e Associati Editori, Milano; 2001.
  7. Gacci M, Simonato A, Masieri L, et al. Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease-free survivors after radical prostatectomy. Health Qual Life Outcomes. 2009;7:94. doi:10.1186/1477-7525-7-94
  8. Gacci M, Livi L, Paiar F, et al. Quality of life after radical treatment of prostate cancer: validation of the  Italian version of the University of California-Los Angeles Prostate Cancer Index. Urology. 2005;66(2):338-343. doi:10.1016/j.urology.2005.02.027
  9. Porreca A, Noale M, Artibani W, et al. Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: the Pros-IT CNR study. Health Qual Life Outcomes. 2018;16(1):122. doi:10.1186/s12955-018-0952-5
  10. Buglione M, Id MN, Id AB, et al. Treatment paths for localised prostate cancer in Italy : The results of a multidisciplinary, observational , prospective study ( Pros-IT CNR ). PLoS One. 2019;14(11):1-14.
  11. Antonelli A, Palumbo C, Noale M, et al. Overview of potential determinants of radical prostatectomy versus radiation therapy in management of clinically localized prostate cancer: results from an Italian, prospective, observational study (the Pros-IT CNR study). Minerva Urol Nefrol. 2020;72(5):595-604. doi:10.23736/S0393-2249.19.03637-3
  12. Antonelli A, Palumbo C, Noale M, et al. Impact of Surgical Approach on Patient-Reported Outcomes after Radical Prostatectomy: A Propensity Score-Weighted Analysis from a Multicenter, Prospective, Observational Study (The Pros-IT CNR Study). Urol Int. 2019;103(1). doi:10.1159/000496980
  13. Palumbo C, Bruni A, Antonelli A, et al. Health-related quality of life 24-month after prostate cancer diagnosis: an update from the Pros-IT CNR prospective observational study. Minerva Urol Nefrol. Published online January 2021. doi:10.23736/S0393-2249.20.04032-1
  14. Gacci M, Greco I, Artibani W, et al. The waiting time for prostate cancer treatment in Italy: analysis from the Pros-IT CNR study. Minerva Urol Nefrol. Published online November 2020. doi:10.23736/S0393-2249.20.03925-9

Read the Abstract