How often do we operate on insignificant prostate cancers?

25 How often do we operate on insignificant prostate cancers? Tomašković I.1, Pezelj I.2, Nikles S.2, Neretljak I.3, Tomić M.2, Miličić V.4, Ružić B.2 1 Medical School Osijek and University Hospital Center "Sestre Milosrdnice", Dept. of Urology, Zagreb, Croatia, 2University Hospital Center Sestre Milosrdnice, Dept. of Urology, Zagreb, Croatia, 3University Hospital Merkur, Dept. of Urology, Zagreb, Croatia, 4University Hospital Center Osijek and Medical School Osijek, Dept. of Cytology, Osijek, Croatia INTRODUCTION & OBJECTIVES: To examine the prevalence of indolent (clinically insignificant) prostate cancers in a population of patients who underwent radical prostatectomy for clinically localized prostate cancer at University Hospital Center "Sisters of Mercy" from 01.01.2004 until 31.12.2014, and trends within that period and to establish the descriptive characteristics of that cohort. MATERIAL & METHODS: In the last 11 years, from 01.01.2004 until 31.12.2014, 1,779 patients were subjected to radical prostatectomy for clinically localized prostate cancer at the Clinical Hospital "Sisters of Mercy". Hospital records: history, operative and histopathological findings were used for data collection. Indolent or clinically insignificant cancer was considered when T2 cancer, Gleason sum ≤6 without Gleason grade 4 prostate cancer, was found in <5% of the total prostate volume on the final specimen obtained after radical prostatectomy. We analyzed trends in prevalence of indolent cancers in two time intervals: between 2004-2009 and 2010 -2014. RESULTS: The proportion of patients with insignificant prostate cancer in a population of patients treated with radical prostatectomy at our institution in the analysed period was 166 out of 1799 (9,2%). In the first time interval 2004-2009, insignificant cancers were observed in 120/836 (14,35%) while in the second examined time interval 2010-2014, insignificant cancers made 46/963 (4,77%) of the operated patients which represents a significant decrease (p<0,001). There were no difference in age (p=0,19), PSA density (p=0,57), number of positive biopsy cores (p=0,45), core percent cancer (p=0,22) or biopsy Gleason score between patients in the two time intervals analysed. Difference was found in total PSA (p=0,03), number of biopsy cores (p<0,001) with slight increase of these in the later interval. During the follow up of mean 56 months no biochemical recurrence was noticed in the entire cohort. CONCLUSIONS: The proportion of patients with insignificant prostate cancer in a population of patients treated with radical prostatectomy at our institution in the entire analysed period was 166 out of 1799 (9,2%). Within that period, recent 5 years show significant decrease in the prevalence of these cancers to 5% of all operated patients. This can in part be explained by adoption of active surveillance and more selective approach to active treatment. The extensive use of PSA and increasing number of treated patients in the last decade has not caused excessive surgical treatment of clinically unimportant prostate cancers. Eur Urol Suppl 2015; 14(6): e1194