Management and Oncologic Outcomes of Incidental Prostate Cancer After Transurethral Resection of the Prostate in Denmark

No AccessJournal of UrologyOriginal Clinical Article31 Jul 2024Management and Oncologic Outcomes of Incidental Prostate Cancer After Transurethral Resection of the Prostate in DenmarkThis article is commented on by the following:Editorial Comment Riccardo Leni, Andrew Julian Vickers, Klaus Brasso, Francesco Montorsi, Alberto Briganti, Torben Kjær Nielsen, Andreas Røder, and Hein Vincent Stroomberg Riccardo LeniRiccardo Leni https://orcid.org/0000-0003-0779-0984 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy , Andrew Julian VickersAndrew Julian Vickers https://orcid.org/0000-0003-1525-6503 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York , Klaus BrassoKlaus Brasso https://orcid.org/0000-0001-6562-6416 Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark , Francesco MontorsiFrancesco Montorsi Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy , Alberto BrigantiAlberto Briganti https://orcid.org/0000-0002-2178-0494 Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy , Torben Kjær NielsenTorben Kjær Nielsen https://orcid.org/0000-0003-3538-2961 Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark , Andreas RøderAndreas Røder https://orcid.org/0000-0002-0019-5333 Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark , and Hein Vincent StroombergHein Vincent Stroomberg Corresponding Author: Hein Vincent Stroomberg, PhD, Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Ole maaloes vej, opgang 75, 2. sal, afsnit 7521, Kobenhavn, Hovedstaden 2200, Denmark ([email protected]) https://orcid.org/0000-0002-7293-9506 View All Author Informationhttps://doi.org/10.1097/JU.0000000000004159AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Approximately 1 in 10 patients without prior prostate biopsy undergoing surgery for lower urinary tract symptoms harbors incidental prostate cancer; however, practice guidelines do not provide recommendations for its management. We aimed at describing the oncologic outcomes of patients with Grade Group (GG) 1 and GG2 prostate cancer diagnosed at transurethral resection of the prostate (TURP). Materials and Methods: This was a nationwide, population-based, observational study of patients undergoing TURP in Denmark from 2006 to 2022 using the Danish Prostate Registry. We estimated the cumulative incidence of further biopsies and MRI, curative treatment, endocrine treatment, and cause-specific mortality with competing risk analyses. Results: Among 24,494 patients who underwent TURP, there were 1016 men with GG1 and 381 with GG2 prostate cancer. The 5-year cumulative incidence of further MRIs or biopsies was 36% (95% CI 33%-39%) for GG1 and 30% (95% CI 25%-34%) for GG2 disease. Fifteen-year prostate cancer mortality was 8.4% (95% CI 5.3%-11%) for GG1 and 14% (7.5%-21%) for GG2. A total of 270 men with GG1 disease underwent a biopsy after the TURP, and 162 (60%) had no cancer; in this group, prostate cancer mortality after 15 years was 0.6% (95% CI 0%-1.8%). Men with post-TURP biopsy ≥ GG2 had a prostate cancer mortality of 30% (95% CI 9%-50%) 15 years post TURP. The major limitation was the heterogeneous follow-up, which could lead to an overestimation of prostate cancer mortality compared to a more standardized follow-up. Conclusions: We observed high prostate cancer mortality after TURP with GG1 or GG2, likely due to unsampled high-grade cancer in the peripheral zone. Patients with incidental prostate cancer should be further investigated to rule out high-grade cancer. For patients with GG1 on TURP, once a subsequent biopsy does not show cancer, follow-up should be lessened similar to that of patients with an initial nonmalignant biopsy. REFERENCES 1. . 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Dr Capitanio, editorial board member of The Journal of Urology®, was recused from the editorial and peer review processes due to affiliation with Vita-Salute San Raffaele University. Funding/Support: This work was supported in part by the National Institutes of Health/National Cancer Institute with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748), a SPORE Grant in Prostate Cancer from Dr H. Scher (P50-CA92629), and the Sidney Kimmel Center for Prostate and Urologic Cancers. Conflict of Interest Disclosures: Dr Vickers reported financial interest and/or other relationship with Opko, Arctic Partners, Steba, and Insightec. Dr Stroomberg reported receiving travel expenses and speaking and lecture fees from MSD Denmark, and project support from Pfizer outside the scope of this manuscript. Dr Nielsen reported prior financial interest and/or other relationship with Recordati, Amgen, and Astellas. Dr Røder reported receiving payment for genetic analyses for Bayer Denmark and Pfizer Denmark, prior speaker's fee Astellas Nordic, and advisory roles and consultancy for Pfizer, Amgen, MSD, Sanofi, Janssen, Astra-Zeneca, Recordati, Astellas, Bayer, Orion, Ferring, Medtronic, and Intuitive. No other disclosures were reported. Ethics Statement: The Danish Health Authorities developed an online platform where all Danish health registries can be accessed upon regulatory approval. This platform is termed "The Research Machine" (Forskermaskinen) and is administered by the Danish Health Data Authority, which is part of the Danish Ministry of Health. All data for this study were generated through this platform according to contemporary Danish data protection policies. The study received Institutional Review Board approval (IRB No. P-2022-342). Author Contributions: Conception and design: Stroomberg, Leni, Brasso, Montorsi, Briganti, Nielsen, Røder. Data acquisition: Stroomberg. Data analysis and interpretation: Stroomberg, Leni, Vickers, Brasso, Montorsi, Nielsen, Røder. Drafting the manuscript: Leni, Brasso, Montorsi. Critical revision of the manuscript for scientific and factual content: Stroomberg, Leni, Vickers, Brasso, Montorsi, Briganti, Nielsen, Røder. Statistical analysis: Stroomberg, Leni, Vickers. Supervision: Stroomberg, Leni, Brasso, Montorsi, Briganti, Nielsen, Røder. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited by Leni R, Vertosick E, van den Bergh R, Soeterik T, Heetman J, van Melick H, Roscigno M, La Croce G, Da Pozzo L, Olivier J, Zattoni F, Facco M, Dal Moro F, Chiu P, Wu X, Heidegger I, Giannini G, Bianchi L, Lampariello L, Quarta L, Salonia A, Montorsi F, Briganti A, Capitanio U, Carlsson S, Vickers A and Gandaglia G (2024) Oncologic Outcomes of Incidental Versus Biopsy-diagnosed Grade Group 1 Prostate Cancer: A Multi-institutional StudyEuropean Urology Open Science, 10.1016/j.euros.2024.08.004, VOL. 68, (10-17), Online publication date: 1-Oct-2024. Siemens D and Routh J Editors' ChoiceJournal of Urology, Strasser M, Patel N and Al Hussein Al Awamlh B Editorial CommentJournal of Urology, Related articlesJournal of Urology2 Aug 2024Editorial Comment Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordstransurethral resection of the prostateincidental prostate cancerprostate cancer–specific mortalityMetrics Author Information Riccardo Leni Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy More articles by this author Andrew Julian Vickers Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York More articles by this author Klaus Brasso Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark More articles by this author Francesco Montorsi Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy More articles by this author Alberto Briganti Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy More articles by this author Torben Kjær Nielsen Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark More articles by this author Andreas Røder Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark More articles by this author Hein Vincent Stroomberg Corresponding Author: Hein Vincent Stroomberg, PhD, Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Ole maaloes vej, opgang 75, 2. sal, afsnit 7521, Kobenhavn, Hovedstaden 2200, Denmark ([email protected]) More articles by this author Expand All Recusal: Dr Matulewicz, reviewer board member of The Journal of Urology®, was recused from the editorial and peer review processes due to affiliation with Memorial Sloan Kettering Cancer Center. Dr Nocera, reviewer board member of The Journal of Urology®, was recused from the editorial and peer review processes due to affiliation with IRCCS Ospedale San Raffaele. Dr Capitanio, editorial board member of The Journal of Urology®, was recused from the editorial and peer review processes due to affiliation with Vita-Salute San Raffaele University. Funding/Support: This work was supported in part by the National Institutes of Health/National Cancer Institute with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748), a SPORE Grant in Prostate Cancer from Dr H. Scher (P50-CA92629), and the Sidney Kimmel Center for Prostate and Urologic Cancers. Conflict of Interest Disclosures: Dr Vickers reported financial interest and/or other relationship with Opko, Arctic Partners, Steba, and Insightec. Dr Stroomberg reported receiving travel expenses and speaking and lecture fees from MSD Denmark, and project support from Pfizer outside the scope of this manuscript. Dr Nielsen reported prior financial interest and/or other relationship with Recordati, Amgen, and Astellas. Dr Røder reported receiving payment for genetic analyses for Bayer Denmark and Pfizer Denmark, prior speaker's fee Astellas Nordic, and advisory roles and consultancy for Pfizer, Amgen, MSD, Sanofi, Janssen, Astra-Zeneca, Recordati, Astellas, Bayer, Orion, Ferring, Medtronic, and Intuitive. No other disclosures were reported. Ethics Statement: The Danish Health Authorities developed an online platform where all Danish health registries can be accessed upon regulatory approval. This platform is termed "The Research Machine" (Forskermaskinen) and is administered by the Danish Health Data Authority, which is part of the Danish Ministry of Health. All data for this study were generated through this platform according to contemporary Danish data protection policies. The study received Institutional Review Board approval (IRB No. P-2022-342). Author Contributions: Conception and design: Stroomberg, Leni, Brasso, Montorsi, Briganti, Nielsen, Røder. Data acquisition: Stroomberg. Data analysis and interpretation: Stroomberg, Leni, Vickers, Brasso, Montorsi, Nielsen, Røder. Drafting the manuscript: Leni, Brasso, Montorsi. Critical revision of the manuscript for scientific and factual content: Stroomberg, Leni, Vickers, Brasso, Montorsi, Briganti, Nielsen, Røder. Statistical analysis: Stroomberg, Leni, Vickers. Supervision: Stroomberg, Leni, Brasso, Montorsi, Briganti, Nielsen, Røder. Advertisement PDF downloadLoading ...