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Changes in risk-group stratification of patients undergoing radical prostatectomy at the Southern Alberta Institute of Urology over time

Authors Shiff B, Patel P, Trpkov K, Gotto GT

Received 27 September 2018

Accepted for publication 4 February 2019

Published 20 March 2019 Volume 2019:11 Pages 69—75


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Jan Colli

Benjamin Shiff,1 Premal Patel,1 Kiril Trpkov,2 Geoffrey T Gotto3

1Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; 2Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada; 3Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada

Introduction: Prostate cancer is the most common cancer among men, but overall mortality rates remain low, due to the preponderance of low-risk disease. Over the last decade, there has been a shift toward more conservative management in low-risk prostate cancer, in order to minimize unnecessary intervention. This study aimed to evaluate the number of low-risk radical prostatectomies (RPs) being performed at the Southern Alberta Institute of Urology over a 10-year period.
Methods: We retrospectively reviewed all patients who underwent RP from 2005 to 2014 at our institution. Patients were stratified by D’Amico risk classification and grade group based on 12-core transrectal ultrasound–guided biopsy (TRUS-bx) results. RP findings are reported from February 2005 to October 2014 to describe concordance between TRUS-bx and RPs. Basic descriptive analyses were used for this study.
Results: Over the study period, 2,310 RPs were performed in our institution. Overall, 35.2% of these were performed on men with low-risk prostate cancer. From 2005 to 2014, the proportion of RPs performed for low-risk prostate cancer dropped from 54.0% to 8.9%, and 49.8% of patients who underwent RP for low-risk disease experienced pathologic upgrading, though only 3.8% were upgraded to grade group 3 or greater. Other adverse pathological findings were uniformly low among the low-risk group.
Conclusion: The proportion of patients undergoing RP at our center for low-risk prostate cancer decreased significantly over the 10 years evaluated in this study, reflecting current global trends toward active surveillance in the management of low-risk prostate cancer.

Keywords: radical prostatectomy, prostate cancer, active surveillance

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