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Minerva Urologica e Nefrologica 2020 Jan 07

DOI: 10.23736/S0393-2249.19.03637-3


lingua: Inglese

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)

Alessandro ANTONELLI 1 , Carlotta PALUMBO 1, Marianna NOALE 2, Walter ARTIBANI 3, Pierfrancesco BASSI 4, Filippo BERTONI 5, Sergio BRACARDA 6, Alessio BRUNI 7, Renzo CORVÒ 8, Mauro GACCI 9, Stefano M. MAGRINI 10, Rodolfo MONTIRONI 11, Angelo PORRECA 12, Andrea TUBARO 13, Vittorina ZAGONEL 14, Stefania MAGGI 2, and the Pros-IT CNR study group 

1 Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy; 2 Section of Padua, Aging Branch, Neuroscience Institute, National Research Council of Italy, Padua, Italy; 3 Urology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; 4 Urology Department, Policlinico Gemelli, Catholic University of Rome, Rome, Italy; 5 Prostate Group of AIRO - Italian Association for Radiation Oncology, Milan, Italy; 6 Medical Oncology Department, Azienda USL Toscana Sud-Est, Istituto Toscano Tumori, Arezzo, Italy; 7 Radiotherapy Unit, University Hospital of Modena, Modena, Italy; 8 Radiation Oncology Unit, IRCCS San Martino, Genoa, Italy; 9 Urology Unit, Careggi Hospital, University of Florence, Florence, Italy; 10 Radiation Oncology Unit, Spedali Civili Hospital of Brescia, University of Brescia, Italy; 11 Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy; 12 Urology Unit, Policlinico di Abano Terme, Padua, Italy; 13 Urology Unit, Sant'Andrea Hospital, University of Rome "La Sapienza", Rome, Italy; 14 Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy


BACKGROUND: We assessed patients and tumor characteristics, as well as health-related quality of life (HRQoL) items, associated with curative intent treatment decision-making in clinically localized prostate cancer (PCa) patients.
METHODS: Clinically localized PCa treated with either radical prostatectomy (RP) or radiation therapy (RT) within 12 months from diagnosis were abstracted from The PROState cancer monitoring in ITaly, from the National Research Council (Pros-IT CNR) database. Multivariable logistic regression (MLR) models predicting RT vs. RP were fitted, after adjustment for HRQoL items, patients and tumor characteristics.
RESULTS: Of 1 041 patients, 631 (60.2%) were treated with RP and 410 (39.8%) with RT. Relative to RT, RP patients were younger age (mean age 64.5±6.6 vs. 71.4±4.9, p<0.001) and had higher rates of D’Amico low-intermediate risk groups (31.8 vs. 21.9% low, 46.3 vs. 43.5% intermediate and 21.9 vs. 34.6% high risk, p<0.001). Overall, 93.2% of RP patients were enrolled by Urologists and 82.7% of RT patients by Radiation Oncologists. RP patients had generally higher means values of HRQoL items. In MLR models, higher RT rates were independently associated with more advanced age (odds ratio [OR] 6.14, p<0.001) and BMI ≥30 kg/m2 (OR 1.78, p<0.001). Conversely, lower rates of RT were independently associated with married (OR 0.55, p=0.01) and worker status (OR 0.52, p=0.004), enrollment in academic centers (OR 0.59, p=0.005) and higher physical composite score (OR 0.88, p=0.03) and baseline sexual function (OR 0.92, p<0.001) items.
CONCLUSIONS: Most patients with clinically localized prostate cancer undergoing definitive treatment at Italian institutions receive RP instead of RT. Moreover, those who are younger, married, working, as well as those with better physical and sexual function are more likely to undergo surgery.

KEY WORDS: Ocalized prostate cancer; Radical prostatectomy; Radiation therapy; Decision-making; Health related quality of life

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