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Minerva Urology and Nephrology 2021 Apr 22

DOI: 10.23736/S2724-6051.21.04174-4


language: English

The impact of age on pathological insignificant prostate cancer rates in contemporary robot-assisted prostatectomy patients despite active surveillance eligibility

Sami-Ramzi LEYH-BANNURAH , Christian WAGNER, Andreas SCHUETTE, Mustapha ADDALI, Nikolaos LIAKOS, Katarina URBANOVA, Mikolaj MENDREK, Matthias OELKE, Jorn H. WITT

Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany

BACKGROUND: To assess insignificant prostate cancer(iPCa) rates after robot-assisted radical prostatectomy (RARP) in contemporary patients who were preoperatively eligible for active surveillance(AS). IPCa indicates no risk of PCa progression.
METHODS: We retrospectively analysed 2,837 RARP patients (2010-2019) who fulfilled at least one AS entry criteria set - Prostate Cancer Research International - Active Surveillance(PRIAS), University of California San Francisco(UCSF), National Comprehensive Cancer Network(NCCN) or University of Toronto. We utilized four different iPCa definitions, (1) based on pT2 and Gleason score ≤6 and also cumulative tumor-volume (2) ≤2.5mL, (3) ≤0.7mL or (4) ≤0.5mL. For each AS set we tested the rates of iPCa and compared between age <70 vs. ≥70 yrs. This was complemented by multivariable logistic regression(LRM) predicting iPCa, adjusted for age and clinical AS variables. Finally, within the subgroup, who had iPCa, we tested rate of those, who were deemed preoperatively AS ineligible.
RESULTS: Between most(PRIAS) and least stringent(TORONTO) AS sets, iPCa(1) was correctly predicted in 70-57%. Similarly, for iPCa definitions 2-4, rates were (2)59-42%, (3)34-19% and (4)27-14%. Senior patients harbored decreased proportions of iPCa. LRM confirmed that advanced age is associated with a lower chance of iPCa. More stringent AS sets lead to higher rates of AS ineligibility, e.g. 53% for PRIAS, despite iPCa.
CONCLUSIONS: AS sets show limited accuracy for stricter iPCa definitions, which further declined with advanced age. Greater AS stringency resulted in more AS ineligible patients despite harboring iPCa. In consequence, patients are at risk for overtreatment. Clinicians must consider age and different AS sets that result in highly variable detection rates of iPCa.

KEY WORDS: Prostate cancer, Active surveillance, Gleason Score; Paired comparison; Tumor staging; Tumor volume

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