Changes in risk-group stratification of patients undergoing radical prostatectomy at the Southern Alberta Institute of Urology over time
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 reviewers approved by Dr Amy Norman
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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