Radical prostatectomies for treatment of prostate cancer: trends in a ten-year period in public health services in the city of São Paulo, Brazil

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ABSTRACT

Objective

To analyze the characteristics of public health services related to radical prostatectomy, according to hospital volume of surgeries and stratified as academic and non-academic centers.

Methods

An ecological study was conducted using a database available in TabNet platform of the Unified Health System Department of Informatics. Number of surgeries, length of hospital stay, length of stay in intensive care unit, in-hospital mortality rate, and cost of hospitalization were evaluated. The hospitals were divided into three subgroups according to surgery volume (tercile), and results were compared. The same comparisons were made among academic and non-academic centers. We considered academic centers those providing Urology residency program.

Results

A total of 11,259 radical prostatectomies were performed in the city of São Paulo between 2008 and 2018. We observed a significant trend of increase in radical prostatectomies for treating prostate cancer over the years (p=0.007). The length of stay in intensive care unit, and number of deaths were not statistically different among centers with diverse surgery volume, nor between academic and non-academic centers. However, length of hospital stay was significantly shorter in academic centers (p=0.043), while cost of hospitalization was significantly higher in high-volume center compared to low- (p<0.001) and intermediate-volume centers (p<0.001).

Conclusion

Length of hospital stay for radical prostatectomies performed in public services in the city of São Paulo was shorter in academic centers, whereas hospitals with a high volume of surgeries showed greater cost of hospitalization.

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Most cited references 17

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Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Ahmedin Jemal, Lindsey A Torre, Rebecca Siegel … (2018)

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

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10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.

Freddie Hamdy, Jenny L Donovan, J Athene Lane … (2016)

Background The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. Methods We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. Results There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison). Conclusions At a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring. (Funded by the National Institute for Health Research; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 .).

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THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION?

A. B. Hill (1965)

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Author and article information

Contributors

Lucas Seiti Takemura:

ORCID: https://orcid.org/0000-0001-6683-5797

Role: conceptualizationRole: data curationRole: formal analysisRole: investigationRole: methodologyRole: writing - original draftRole: writing - review & editing

Álan Roger Gomes Barbosa:

ORCID: https://orcid.org/0000-0001-9892-6458

Role: formal analysisRole: investigation

Breno Santos Amaral:

ORCID: https://orcid.org/0000-0002-4586-8183

Role: formal analysisRole: investigation

Alvaro Alexandre Dias Bosco:

ORCID: https://orcid.org/0000-0001-6656-5758

Role: formal analysisRole: investigation

Danilo Budib Lourenço:

ORCID: https://orcid.org/0000-0002-7536-1148

Role: formal analysisRole: investigation

Marcelo Apezzato:

ORCID: https://orcid.org/0000-0003-1068-6600

Role: writing - original draftRole: writing - review & editingRole: performed critical revision of the manuscript for important intellectual content

João Arthur Brunhara Alves Barbosa:

ORCID: https://orcid.org/0000-0001-9646-8588

Role: formal analysisRole: writing - review & editingRole: writing - original draft

Eliney Ferreira Faria:

ORCID: https://orcid.org/0000-0002-8297-3417

Role: formal analysisRole: visualization

Bianca Bianco:

ORCID: https://orcid.org/0000-0001-8669-3562

Role: writing - original draftRole: writing - review & editing

Gustavo Caserta Lemos:

ORCID: https://orcid.org/0000-0001-8818-4964

Role: conceptualizationRole: supervisionRole: writing - review & editingRole: performed critical revision of the manuscript for important intellectual content

Arie Carneiro:

ORCID: https://orcid.org/0000-0002-0152-0513

Role: conceptualizationRole: formal analysisRole: writing - original draftRole: writing - review & editingRole: supervision

Journal

Journal ID (nlm-ta): Einstein (Sao Paulo)

Journal ID (iso-abbrev): Einstein (Sao Paulo)

Journal ID (publisher-id): eins

Title: Einstein

Publisher: Instituto Israelita de Ensino e Pesquisa Albert Einstein

ISSN (Print): 1679-4508

ISSN (Electronic): 2317-6385

Publication date (Electronic): 18 November 2022

Publication date Collection: 2022

Volume: 20

Electronic Location Identifier: eAO0049

Affiliations

[1 ] orgnameHospital Israelita Albert Einstein São Paulo SP Brazil originalHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

[2 ] orgnameHospital de Amor, Barretos Barretos SP Brazil originalHospital de Amor, Barretos, SP, Brazil.

Author notes

Corresponding author: Arie Carneiro, Department of Urology Avenida Albert Einstein, 627/701, building A1, room 303 - Morumbi, Zip code: 05652-900 - São Paulo, SP, Brazil, Phone: (55 11) 2151-3333, E-mail: arie.carneiro@ 123456einstein.br

Conflict of interest:

none.