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ORIGINAL ARTICLE   Free accessfree

Minerva Urologica e Nefrologica 2020 October;72(5):595-604

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,, the Pros-IT CNR study group 

1 Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy; 2 Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy; 3 Unit of Urology, University Hospital of Verona, Verona, Italy; 4 Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; 5 Prostate Group of AIRO (Italian Association for Radiation Oncology), Milan, Italy; 6 Department of Medical Oncology, USL Toscana Sud-Est, IRCCS Istituto Nazionale Tumori Foundation, Arezzo, Italy; 7 Unit of Radiotherapy, University Hospital of Modena, Modena, Italy; 8 Unit of Radiation Oncology, IRCCS San Martino University Hospital, Genoa, Italy; 9 Unit of Urology, Careggi Hospital, University of Florence, Florence, Italy; 10 Unit of Radiation Oncology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy; 11 Section of Pathological Anatomy, School of Medicine, United Hospitals, Marche Polytechnic University, Ancona, Italy; 12 Unit of Urology, Polyclinic of Abano Terme, Padua, Italy; 13 Unit of Urology, Sant’Andrea Hospital, Sapienza University, 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 1041 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 items (OR 0.92, P<0.001).
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: Prostatic neoplasms; Prostatectomy; Radiotherapy; Decision making; Quality of life

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