Active Surveillance for Intermediate-risk Prostate Cancer: A Systematic Review, Meta-analysis, and Metaregression

A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Letter.

“…In a recent systematic review and meta-analysis, we showed that AS was associated with significantly higher risks of metastasis and cancer mortality in unselected patients with intermediate-risk PCa than in patients with low-risk PCa. 3 In subgroup analysis, we also showed in studies excluding GGG 3 intermediaterisk patients that treatment-free survival and metastasisfree survival were similar between low-and intermediaterisk patients. However, to date, the eligibility of intermediate-risk PCa patients for AS is limited by very strict consensus-based inclusion criteria, and these recommendations have been endorsed by the American Society of Clinical Oncology.…”

“…2 Our study had 15% of zero ischemia in the laparoscopic partial nephrectomy group vs 35% in the open partial nephrectomy group, with a median ischemia time of 14 minutes (7-25 minutes) for both groups, demonstrating the hypothesis that ischemia time has a shorter impact in long-term renal function. 3 We believe that image magnification of laparoscopy led the surgeon to perform a better enucleation of the tumor, preserving more healthy tissue.…”

“…So, why should a urologist want to employ CI? The transplant literature (WI beyond 25 minutes results in long lasting diffuse renal damage), [2][3][4] the trauma literature (not dead until warm and dead), and the anatrophic nephrolithotomy surgery studies by Smith and Boyce 5 all support CI over WI in terms of functional organ preservation. The 2 most widely cited renal ischemia studies report WI beyond 20-25 minutes results in chronic diffuse damage to the kidney, whereas CI for up to 58 minutes prevented ischemic injury to the renal remnant.…”

“…The 2 most widely cited renal ischemia studies report WI beyond 20-25 minutes results in chronic diffuse damage to the kidney, whereas CI for up to 58 minutes prevented ischemic injury to the renal remnant. 3,4 Small tumors that are exophytic or contained in the upper or lower renal poles are amenable to either nonischemic laparoscopic resection or shortterm WI. My concern is this study may be used to support LPN over OPN in clinical circumstances where WI is over 20 minutes, and in that circumstance the conclusions of this study do not apply.…”

Gleason Grade 1 Prostate Cancer Volume at Biopsy Is Associated With Upgrading, but Not Adverse Pathology or Recurrence After Radical Prostatectomy: Results From a Large Institutional Cohort. Letter.

“…In a recent systematic review and meta-analysis, we showed that AS was associated with significantly higher risks of metastasis and cancer mortality in unselected patients with intermediate-risk PCa than in patients with low-risk PCa. 3 In subgroup analysis, we also showed in studies excluding GGG 3 intermediate-risk patients that treatment-free survival and metastasis-free survival were similar between low- and intermediate-risk patients. However, to date, the eligibility of intermediate-risk PCa patients for AS is limited by very strict consensus-based inclusion criteria, and these recommendations have been endorsed by the American Society of Clinical Oncology.…”