Evaluation of various active surveillance protocols in prostate cancer.

OBJECTIVE: This study aims to investigate whether pathology results obtained by radical retropubic prostatectomy (RRP) were correlated with active surveillance (AS) criteria defined by Klotz, Soloway and D'Amico. MATERIALS AND METHODS: In our clinic we evaluated 211 patients with diagnosis of localized prostate cancer who underwent RRP between 2007 and 2012. AS criteria defined by Soloway (cT ≤ T2, PSA ≤ 15 ng/dl, Gleason ≤ 6), Klotz (cT1c-T2a; if age ≥ 70 PSA ≤ 15 ng/dl, if age < 70 PSA ≤ 10 ng/dl; if age ≥ 70 Gleason ≤ 7(3+4), if age < 70 Gleason ≤ 6) and D'Amico (cT1c-T2a, PSA ≤ 10 ng/dl, Gleason ≤ 6) were used in our study. Pathological stages and Gleason scores were evaluated with coherence to AS protocols, mis-staging rates, biochemical recurrence (BC) of the mis-staged patients and death due to prostate cancer Data was analyzed using NCSS 2007 & PASS 2008 Statistical Software (Utah, USA). Chi square test and Mann-Whitney U test were applied for analyzing qualitative data. Significance was determined as p < 0.05. RESULTS: 137 (64.9%) patients were coherent with Soloway AS criteria, 118 (55.9%) with Klotz AS criteria and 108 (51.1%) with D'Amico AS criteria. Histopathological results of the patients grouped according to Soloway, Klotz and D'Amico AS protocols showed high stage prostate cancer in 40 (29.2%), 32 (27%) and 27 (24.9%) patients, respectively. High grade prostate cancer rates in Soloway, Klotz, D'Amico groups were 55 (40.2%), 46 (38%) and 39 (36.1%); respectively. Misstaging rates of Soloway, Klotz and D'Amico AS protocols were determined as 65 (47.4%), 54 (45.5%) and 46 (42.5%), respectively. In the Soloway group BC rate was 21.9% in those with high stages. Relation between BC and high stage was found to be statistically significant (p < 0.05). CONCLUSION: Misstaging rates were relatively high in the three groups and there was no difference between the three groups in BC rates. Randomized studies with adequate follow up are needed.

The effects of pelvic dimensions on radical retropubic prostatectomy.

INTRODUCTION: To determine the effects of pelvic dimensions on margin status, preoperative and postoperative estimated blood loss (EBL), operative time and transfusion rate (TR) during radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: Data from 94 patients with preoperative prostate MRI were analyzed. Pelvic dimensions, including interspinous distance (ISD), bony (BFW) and soft tissue (SW) pelvic width, apical prostate depth, upper conjugate (UC), lower conjugate (LC) were measured by preoperative MRI. Indexes for pelvic dimensions (PDI), bony width (BWI) and soft-tissue width (SWI) were defined as ISD/AD, BFW/PD, and SW/AD, respectively. As indicators of surgical difficulty, TR and EBL were assessed. SPSS version 17.0 was used for statistical analyses. RESULTS: Correlational analysis revealed no significant relationship between pelvic dimensions and parameters reflecting operative difficulty (p > 0.05). For EBL, there were significant indirect correlations between the BFW/AD, ISD/AD, and SW/AD indexes (p < 0.01, p < 0.01, p < 0.05; respectively). Additionally, the correlations between AD and TR (p < 0.05) and between AD and EBL (p < 0.05) were significant. Consequently, TR was significantly correlated with BFW/AD, ISD/AD and SW/AD (p < 0.01, p < 0.05, p < 0.01; respectively). Correlational analysis revealed that prostate volume (PV) was significantly correlated with EBL and TR (p < 0.01). Multivariate analyses revealed that PV was a significant predictor of TR (p = 0.06). None of the pelvic dimensions were significantly associated with recovery of urinary continence (RUC) (p > 0.05). CONCLUSIONS: Analyses of pelvic dimensions as significant factors influencing operative difficulty during RRP yielded mixed results. PV seems to be the strongest factor related to operative difficulty. Future studies about pelvic dimensions should be conducted.