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Comparative Study
. 2021 May;39(5):1445-1452.
doi: 10.1007/s00345-020-03350-5. Epub 2020 Aug 1.

How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study

Mauro Gacci  1 , Walter Artibani  2 , Pierfrancesco Bassi  3 , Filippo Bertoni  4 , Sergio Bracarda  5 , Alberto Briganti  6 , Giorgio Carmignani  7 , Luca Carmignani  8 , Giario Conti  9 , Renzo Corvò  10 , Cosimo De Nunzio  11 , Ferdinando Fusco  12 , Pierpaolo Graziotti  13 , Isabella Greco  14 , Stefania Maggi  15 , Stefano Maria Magrini  16 , Vincenzo Mirone  12 , Rodolfo Montironi  17 , Giuseppe Morgia  18 , Giovanni Muto  19 , Marianna Noale  15 , Stefano Pecoraro  20 , Angelo Porreca  21 , Umberto Ricardi  22 , Elvio Russi  23 , Giorgio Russo  18 , Andrea Salonia  24 , Alchiede Simonato  25 , Sergio Serni  14 , Davide Tomasini  16 , Andrea Tubaro  11 , Vittorina Zagonel  26 , Gaetano Crepaldi  15 ; MIRROR-SIU/LUNA Study Group and the Pros-IT CNR Study Group
Collaborators, Affiliations
Comparative Study

How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study

Mauro Gacci et al. World J Urol. 2021 May.

Abstract

Purpose: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy.

Methods: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND).

Results: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies.

Conclusions: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.

Keywords: Lymph node dissection; MIRROR SIU/LUNA study; Nerve sparing; Pros-IT CNR study; Prostate cancer; Robotic procedures.

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References

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