Active Surveillance for Low-Risk Prostate Cancer: The Uphill Battles and the Unnecessary Ones

Chen, Kenneth; Murphy, Declan; Lawrentschuk, Nathan

doi:10.1097/ju.0000000000002348

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…These type of patients should benefit the most from T-RARP, since active surveillance was controversial in them [16]. Although there were still 42% men belonging to grade group 1, many factors would still affect the choice of active surveillance such as patients' compliance and lack of evidence supporting the selection criteria and surveillance protocols [17]. In a large cohort study, 36% men would change to definite therapies after 5-year active surveillance [18].…”

Section: Discussionmentioning

confidence: 99%

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Hsu,

Yang,

Tung

et al. 2023

Cancers

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Objective: This study aimed to explore the benefits of theranostic robot-assisted radical prostatectomy (T-RARP) for clinically highly suspicious prostate cancer (PCa) without proven biopsies. Material and Methods: Between February 2016 and December 2020, we included men with clinically highly suspicious PCa in this study. They were assessed to have possible localized PCa without any initial treatments, and were categorized into previous benign biopsies or without biopsies. Furthermore, another group of malignant biopsies with RARP in the same time frame was adopted as the control group. The endpoints were to compare the oncological outcome and functional outcome between malignant biopsies with RARP and T-RARP. p < 0.05 was considered to be significant. Results: We included 164 men with proven malignant biopsies treated with RARP as the control group. For T-RARP, we included 192 men. Among them, 129 were preoperatively benign biopsies, and 63 had no biopsies before T-RARP. Approximately 75% of men in the T-RARP group had malignant pathology in their final reports, and the other 25% had benign pathology. T-RARP provides several oncological advantages, such as a higher initial pathological T stage, lower Gleason grade, and lower odds of positive surgical margins. However, the biochemical recurrence rates were not significantly decreased. From our cohort, T-RARP (odds ratio with 95% confidence interval; erectile recovery: 3.19 (1.84–5.52), p < 0.001; continence recovery: 2.25 (1.46–3.48), p < 0.001) could result in better recovery of functional outcomes than malignant biopsies with RARP. Conclusions: For clinically highly suspicious PCa, T-RARP was able to detect around 75% of PCa cases and preserved their functional outcomes maximally. However, in 25% of men with benign pathology, approximately 6% would have incontinence and 10% would have erectile impairment. This part should be sufficiently informed of the potential groups considering T-RARP.

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Section: Discussionmentioning

confidence: 99%

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Hsu,

Yang,

Tung

et al. 2023

Cancers

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“…The management of low‐risk prostate cancer in North America has recently seen some unexpected, surprising, and somewhat perplexing occurrences. The sudden change in the National Comprehensive Cancer Network (NCCN) guidelines last year, no longer recommending active surveillance (AS) as the ‘preferred’ treatment for low‐risk prostate cancer, caused confusion and concern for many alarmed that such guidance could potentially increase active treatment rates in men unlikely to benefit from intervention [1]. Fortunately, this ‘enlightened guidance’ was subsequently reversed shortly thereafter.…”

Section: Disclosure Of Interestsmentioning

confidence: 99%

Active surveillance versus enzalutamide for low‐risk prostate cancer – was it really a trial we needed?

et al. 2022

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Active Surveillance for Low-Risk Prostate Cancer: The Uphill Battles and the Unnecessary Ones

Cited by 2 publications

References 6 publications

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood

Active surveillance versus enzalutamide for low‐risk prostate cancer – was it really a trial we needed?

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