Active surveillance or radical prostatectomy? Which treatment is best?

OBJECTIVE: We evaluated the patients who are candidates for active surveillance and treated with radical prostatectomy. These patients were compared with other patients who had not met the criteria of active surveillance. METHODS: In total, 135 patients were included in the study. The patients were divided into two groups. The patients in Group 1 had less than three positive cores, Gleason 6 (3 + 3) and PSA level equal to or less than 10 ng/ml. Patients in Group 2 had three or more positive cores, Gleason 6 (3 + 3) and PSA level equal to or higher than 10 ng/ml. Pathological results of each groups were compared. RESULTS: The patients' ages were between 52 and 76, and 50 and 77 in groups 1 and 2, retrospectively. There were 69 and 66 patients in groups 1 and 2, retrospectively. The mean age of patients, PSA levels, PSA density, and prostate volumes were 63.89 ± 5.89 years, 5.82 ± 1.84 ng/ml, 0.14 ± 0.07 and 51.21 ± 31.75 cc (Group 1) and 65.77 ± 6.36 years, 13.65 ± 17.11 ng/ml, 0.63 ± 1.03 and 45.44 ± 26.77 cc (Group 2). T2a, T2c, T3a and T3b were reported in 28 patients, 36 patients, 3 patients and 2 patients after pathological evaluation in Group 1,respectively. T2a, T2c, T3a and T3b were reported in 13 patients, 47 patients, 5 patients and 1 patient in the other group, respectively. CONCLUSION: The final pathology showed that there is no difference in the positive surgical margin, proportion of insignificant prostate cancer and Gleason upgrading between groups. The clinicians must be aware of the fact that active surveillance can be misdiagnosed in some patients (Tab. 2, Ref. 20).

Question for a questionnaire: the International Index of Erectile Function.

The aim of this study was to analyze the impact of patient age and education level on the comprehension of the Turkish version of Index of Erectile Function (IIEF), and to determine the patient characteristics that make this questionnaire less reliable. In this study, 238 male patients presenting to our clinic were enrolled. The patients were asked to complete the Turkish version of the IIEF questionnaire upon arrival by themselves and then once again during their second visit with the assistance of a physician. 'Accurate' comprehension of the IIEF was considered to be the consistency between the 'self-administered' and 'physician-assisted' IIEF scores. The impact of patient age and education level on the 'accurate' comprehension of the IIEF was analyzed. There was a significant difference between the 'self-administered' and 'physician-assisted' IIEF scores in patients ≥ 60 years of age (P=0.045) and primary school graduates (P=0.015). Age ≥ 60 years and being primary school graduate are factors lowering the comprehension of the Turkish version of the IIEF by the patients. Older patients and patients with lower education could benefit from the assistance of a physician while completing this questionnaire.