Results and Outcomes of Radical Prostatectomy for Low- Risk Prostate Cancer in North African Ethnic Group

Abstract

Background: Prostate cancer (PCa) is a leading cause of cancer death in the world. Indeed, its incidence is increasing with diagnoses made increasingly early thanks to the introduction of screening by prostate-specific antigen (PSA). This detection is done with most often localized stages, causes over diagnosis whose main consequence is overtreatment of the low-risk cancers that would have evolved very slowly and not aggressively without any treatment. Methods: To evaluate the pattern of treatment decisions and oncological outcomes among men aged ? 60 and ? 70 years with low-risk PCa in North African ethnic group, we examined the proportion and outcomes of men with low-risk disease treated with radical prostatectomy (RP) at our institution in the last decade. Results: Median age of the 166 men in the study cohort was 66 years. Mean serum PSA at diagnosis was 5.9 ng/mL with an average ratio of 13.77%. At diagnosis, 70.3% of our patients were symptomatic with lower urinary tract symptom (LUTS) with a suspicious digital rectal examination in 9.7% of cases. Clinical stage was T1a/b in 5.1%, T1c in 79.6% and T2a in 15.3% of the patients. All men had Gleason score (GS) 6 PCa on biopsy and all men were treated with open radical retropubic prostatectomy. Except for age, there was no difference in the clinical features of men aged 65 - 69 and ? 70 years. One hundred percent of cancers are adenocarcinomas. Final pathological review revealed organ-confined disease in 77.1% of the men, extracapsular extension (ECE) in 22%, seminal vesicle invasion (SVI) in 8.6% and lymph node involvement in 3.2%. Conclusion: The challenge lies in identifying the aggressiveness of the cancer at diagnosis, and the ability to predict the individual risk of progression, active surveillance (AS) strategy needs to be validated by long-term results, new therapy options are currently being evaluated, and we consider that RP is an adequate therapy in men with low risk of d’Amico features. World J Nephrol Urol. 2015;4(4):251-255 doi: http://dx.doi.org/10.14740/wjnu241w