Radical prostatectomy for Gleason 3+3 prostate cancer; who, how and why? Analysis of the British Association of Urological Surgeons complex operations database.
BAUS ePoster online library. John J. 11/10/20; 304110; P10-2
Mr. Joseph John
Mr. Joseph John
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Radical prostatectomy for Gleason 3+3 prostate cancer; who, how and why? Analysis of the British Association of Urological Surgeons complex operations database.

John J1, Pascoe J1, Fowler S2, Walton T3, Johnson M4, Aning J5, Challacombe B2,6, Dickinson A2,7, McGrath J1,2
1Royal Devon and Exeter NHS Foundation Trust, United Kingdom, 2British Association of Urological Surgeons, London, United Kingdom, 3Nottingham University Hospitals NHS Trust, United Kingdom, 4Newcastle Upon Tyne NHS Foundation Trust, United Kingdom, 5North Bristol NHS Trust, United Kingdom, 6Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 7University Hospitals Plymouth, United Kingdom

Introduction:
There is a risk of overtreating low-grade prostate cancer (PCa) with radical prostatectomy (RP). A preference for active surveillance for localised Gleason 3+3 disease was advocated in the 2018 UK National Prostate Cancer Audit. This reflects the peri-operative risks and common functional sequalae following RP.

Objectives:
To understand modern RP practices in England for Gleason 3+3 PCa.
Materials and Methods: BAUS manage the complex operations database for RP. Surgical departments upload data describing patient, disease, surgical, pathological and outcome factors. Surgeons can review and amend their data before lockdown and data cleansing. Analysis of all 21,973 RPs recorded in England from 2016-18 was performed to identify 2,627 cases of Gleason 3+3 disease diagnosed pre-operatively.

Results:
Using Hospital episode statistics, the BAUS RP dataset was deemed 91% complete. Gleason 3+3 patients accounted for 12% of RPs. Median patient age was 63 and 89% were ASA 1-2. Median PSA was 7.0 (IQR 5.1–10.4). Intermediate-risk disease was present in 52% (pre-operative T stage ≥2b and/or PSA ≥10). Table 1 further describes disease, surgical and outcome factors. Median LOS was 1 day.

Conclusions:
Decisions to proceed to RP for Gleason 3+3 PCa in England can be commonly justified by pre-operative factors indicating intermediate or high-risk disease, and by post-operative upstaging/upgrading. Further factors that might lead a surgeon to perform RP for locally-confined Gleason 3+3 disease include patient preference, high disease volume, MRI suggesting a higher-grade lesion, and prostate capsule proximity. Peri-operative outcome data indicate that RP in this cohort is safe.
Radical prostatectomy for Gleason 3+3 prostate cancer; who, how and why? Analysis of the British Association of Urological Surgeons complex operations database.

John J1, Pascoe J1, Fowler S2, Walton T3, Johnson M4, Aning J5, Challacombe B2,6, Dickinson A2,7, McGrath J1,2
1Royal Devon and Exeter NHS Foundation Trust, United Kingdom, 2British Association of Urological Surgeons, London, United Kingdom, 3Nottingham University Hospitals NHS Trust, United Kingdom, 4Newcastle Upon Tyne NHS Foundation Trust, United Kingdom, 5North Bristol NHS Trust, United Kingdom, 6Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 7University Hospitals Plymouth, United Kingdom

Introduction:
There is a risk of overtreating low-grade prostate cancer (PCa) with radical prostatectomy (RP). A preference for active surveillance for localised Gleason 3+3 disease was advocated in the 2018 UK National Prostate Cancer Audit. This reflects the peri-operative risks and common functional sequalae following RP.

Objectives:
To understand modern RP practices in England for Gleason 3+3 PCa.
Materials and Methods: BAUS manage the complex operations database for RP. Surgical departments upload data describing patient, disease, surgical, pathological and outcome factors. Surgeons can review and amend their data before lockdown and data cleansing. Analysis of all 21,973 RPs recorded in England from 2016-18 was performed to identify 2,627 cases of Gleason 3+3 disease diagnosed pre-operatively.

Results:
Using Hospital episode statistics, the BAUS RP dataset was deemed 91% complete. Gleason 3+3 patients accounted for 12% of RPs. Median patient age was 63 and 89% were ASA 1-2. Median PSA was 7.0 (IQR 5.1–10.4). Intermediate-risk disease was present in 52% (pre-operative T stage ≥2b and/or PSA ≥10). Table 1 further describes disease, surgical and outcome factors. Median LOS was 1 day.

Conclusions:
Decisions to proceed to RP for Gleason 3+3 PCa in England can be commonly justified by pre-operative factors indicating intermediate or high-risk disease, and by post-operative upstaging/upgrading. Further factors that might lead a surgeon to perform RP for locally-confined Gleason 3+3 disease include patient preference, high disease volume, MRI suggesting a higher-grade lesion, and prostate capsule proximity. Peri-operative outcome data indicate that RP in this cohort is safe.
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