BACKGROUND: The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. OBJECTIVE: We aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. DESIGN, SETTING, AND PARTICIPANTS: We identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. RESULTS AND LIMITATIONS: Overall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). CONCLUSIONS: One out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2-3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. PATIENT SUMMARY: Our novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.

• MeSH
• Humans MeSH
• Lymphadenopathy * pathology   surgery   MeSH
• Lymphatic Metastasis pathology   MeSH
• Lymph Nodes diagnostic imaging   surgery   pathology   MeSH
• Magnetic Resonance Imaging MeSH
• Prostatic Neoplasms * diagnostic imaging   surgery   pathology   MeSH
• Positron Emission Tomography Computed Tomography methods   MeSH
• Positron-Emission Tomography MeSH
• Prostate diagnostic imaging   surgery   pathology   MeSH
• Prostatectomy MeSH
• Prostate-Specific Antigen MeSH
• Seminal Vesicles pathology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: The role of isoforms of prostate specific antigen (PSA) and other kallikrein-related markers in early detection of biochemical recurrence (BCR) after radical prostatectomy (RP) is not well known and serum PSA is currently used in preoperative risk nomograms. OBJECTIVE: The aim of this research was to study pre- and early postoperative levels of important PSA isoforms and human kallikrein-2 to determine their ability to predict BCR and identify disease persistence (DP). METHODS: This study included 128 consecutive patients who underwent RP for clinically localized prostate cancer. PSA, fPSA, %fPSA, [-2]proPSA, PHI and hK2 were measured preoperatively, at 1 and 3 months after RP. We determined the ability of these markers to predict BCR and identify DP. RESULTS: The DP and BCR rate were 11.7%and 20.3%respectively and the median follow up was 64 months (range 3-76 months). Preoperatively, the independent predictors of BCR were PSA (p-value 0.029), [-2]proPSA (p-value 0.002) and PHI (p-value 0.0003). Post-RP, PSA was the single marker correlating with BCR, both at one (p-value 0.0047) and 3 months (p-value 0.0004). PSA, fPSA, [-2]proPSA and PHI significantly correlated to DP at 1 and 3 months post-RP (p-value <  0.05), although PSA had the most significant existing correlation (p-value <  0.0001). CONCLUSIONS: [-2]proPSA and PHI are preoperative predictors of BCR and DP that outperform the currently used serum PSA. At the early postoperative period there is no additional benefit of the other markers tested.

• MeSH
• Early Detection of Cancer MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local blood   diagnosis   genetics   MeSH
• Biomarkers, Tumor blood   MeSH
• Prostatic Neoplasms blood   diagnosis   genetics   surgery   MeSH
• Nomograms MeSH
• Postoperative Period MeSH
• Prostate pathology   surgery   MeSH
• Prostatectomy MeSH
• Prostate-Specific Antigen blood   MeSH
• Protein Isoforms blood   genetics   MeSH
• Aged MeSH
• Neoplasm Grading MeSH
• Tissue Kallikreins blood   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

Rostoucí incidence karcinomu prostaty je jednoznačným důvodem k dalšímu výzkumu v oblasti diagnostiky a léčby tohoto onemocnění. Pokroky v léčbě lokalizovaných, ale především pokročilých stadií jsou v posledních letech skutečně obrovské. Každodenní praxe však ukazuje přetrvávající nedostatky diagnostických metod, obzvláště pak omezené možnosti určení rizikovosti pacientů. Vzhledem k vývoji současných trendů léčby karcinomu prostaty je evidentní nutností odlišit nejen pacienty, kteří mají či nemají karcinom prostaty, ale především posléze identifikovat ty, které toto onemocnění ohrožuje a je třeba jej agresivně léčit. Standardním, praxí a roky ověřeným markerem, splňujícím alespoň částečně tyto požadavky, je prostatický specifický antigen (PSA). Cílem tohoto článku je ukázat výhody, ale i nedostatky využití tohoto tradičního markeru a představit nedávno identifikované izoformy PSA, které mohou v kombinaci se standardním PSA zpřesnit diagnostiku a detekci rizikových pacientů.

The growing incidence of prostate cancer is a clear reason for further research in the field of diagnosis and treatment of this disease. There has been huge progress made in the treatment of localized disease, even bigger in the treatment of advanced stage of prostate cancer. However, dayto- day practice shows persistent shortcomings in diagnostic methods, especially the limited risk assessment of patients. Due to the current trends in prostate cancer treatment, it is apparent that it is not only necessary to distinguish patients who have or do not have prostate cancer, but most importantly to identify those who are at risk and need to be treated aggressively. A standard, practice and time proven marker, at least partially meeting these requirements, is the prostate specific antigen (PSA). The aim of this article is to demonstrate the advantages and disadvantages of using this traditional marker and to present recently identified PSA isoforms that, in combination with standard PSA, can clarify the diagnosis and detection of at-risk patients. Major statement: There are still countless questions in the field of diagnostics and risk prediction of prostate cancer patients.

• Keywords
• určení rizikovosti, izoformy,
• MeSH
• Humans MeSH
• Biomarkers, Tumor * MeSH
• Prostatic Neoplasms * diagnosis   MeSH
• Prostate-Specific Antigen * analysis   blood   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Review MeSH

BACKGROUND AND OBJECTIVE: Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes. MATERIAL AND METHODS: Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value ≥ 0.1 ng/ml, at first PSA-measurement after salvage RP. RESULTS: Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% for patients with persistent vs. undetectable PSA after salvage RP (all p < 0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01). CONCLUSION: Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.

• MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local * pathology   surgery   blood   MeSH
• Biomarkers, Tumor blood   MeSH
• Prostatic Neoplasms * surgery   pathology   blood   mortality   MeSH
• Follow-Up Studies MeSH
• Prognosis MeSH
• Prostatectomy * methods   MeSH
• Prostate-Specific Antigen * blood   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Salvage Therapy * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

The major advantages of urine-based assays are their noninvasive character and ability to monitor prostate cancer with heterogeneous foci. Almost all urine-detectable prostate-specific markers have been recently reviewed. For this reason, we focus here on only a few promising markers which have been independently evaluated (in particular PCA3, fusion genes, TERT, AMACR, GSTP1, MMP9 and VEGF) and very recent ones (ANXA3 and sarcosine). The emphasis is also on multiplex biomarker analysis and on microarray-based analysis of fusion genes. A combination of multiple urine biomarkers may be valuable in the case of men with persistently elevated serum prostate-specific antigen and a history of negative biopsies. The emerging urine tests should help in both early diagnosis of prostate cancer and identifying aggressive tumors for radical treatment.

• MeSH
• Annexin A3 urine   MeSH
• Antigens, Neoplasm urine   MeSH
• Gene Fusion MeSH
• Oncogene Proteins, Fusion urine   MeSH
• Glutathione S-Transferase pi urine   MeSH
• Humans MeSH
• Matrix Metalloproteinase 9 urine   MeSH
• Biomarkers, Tumor urine   MeSH
• Prostatic Neoplasms genetics   urine   MeSH
• Prognosis MeSH
• Prostate-Specific Antigen urine   MeSH
• Racemases and Epimerases urine   MeSH
• Sarcosine urine   MeSH
• Comparative Genomic Hybridization MeSH
• Telomerase urine   MeSH
• Vascular Endothelial Growth Factor A urine   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Background: Prostate cancer (PCa) is the second most common cancerin the male population and represents a major health problem, especially in developed countries, where older men are more prevalent in the general population. Analyzing recent data for European countries, the incidence is highest in Northern and Western Europe (>200 per 100,000), while the rate is lower in Eastern and Southern Europe, but shows a continuous increase. Globally, about 450,000 Europeans are diagnosed with prostate cancer each year, and prostate cancer was the second most common cause of cancer-related deaths in 2018, when it was the cause of death for 107,000 men in Europe. Global data for BiH indicate that PCa is the second most common cancer in the male population, or the third leading cause of death in men due to cancer. Objective: The aim of this study was to analyze (PCa) how PCa screening is the most controversial topic regarding statements described in the urological literature searching most important biomedical on-line databases. Methods: Authors used descriptive method for this systematic study based on the published literature, summarized through meta-analysis, to show that screening was associated with an increase in PCa diagnosis. Results and Discussion: Most of autghors written about this topic and concluded that the greater detection of localized and less advanced PCa disease, but without benefits in the field of PCa “specific survival” and “overall survival”, “overdiagnosis” and “overtreatment”, leading to recommendations against systematic population screening in all countries, including Europe. The main diagnostic tools for diagnosing PCa are digitorectal examination (DRE), serum specific antigen concentration (PSA), transrectal ultrasonography (TRUS) and mp MRI, and the definitive diagnosis is based on pathohistological verification of cancer in prostate biopsy specimens or operative specimen. The indication for biopsy should be determined based on PSA levels and/or suspected DRE, depending on age, potential comorbidities and therapeutic consequences, and the indication for repeated biopsy is an increase or persistently elevated PSA, suspected DRE, “atypical small acinar proliferation” (ASAP), extensive high grade “prostatic intraepithelial neoplasia” (PIN) and positive multiparametric MRI of the prostate (PI-RADS ≥3). Conclusion: PCa volume assessment is based on DRE and PSA with the addition of multiparametric MRI, bone scan and CT, although there are new imaging modalities, such as PET/CT scan and Diffusion-weighted whole-body MRI. However, the cost-effectiveness” of these new approaches needs to be further assessed. Given that COVID-19 has imposed other priorities on all health systems, we hope that the diagnosis of clinically significant prostate cancer and adequate treatment is not questionable at this time

• MeSH
• Acinar Cells pathology   MeSH
• Survival Analysis MeSH
• Biopsy MeSH
• European Union MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Meta-Analysis as Topic MeSH
• Prostatic Neoplasms * diagnosis   epidemiology   prevention & control   MeSH
• Digital Rectal Examination MeSH
• Cell Proliferation MeSH
• Prostate-Specific Antigen analysis   history   MeSH
• Randomized Controlled Trials as Topic MeSH
• Ultrasound, High-Intensity Focused, Transrectal MeSH
• Ultrasonography, Doppler MeSH
• Check Tag
• Humans MeSH
• Male MeSH

Základní léčebné možnosti karcinomu prostaty zahrnují radikální prostatektomii a radioterapii. U řady pacientů je po ukončení léčby prokázáno rostoucí PSA jako známka perzistence onemocnění. Tato elevace PSA bývá často jediným průkazem recidivy karcinomu, která zpravidla předchází klinickou manifestaci o měsíce či roky. Úkolem klinika je pak na podkladě ukazatelů, jako je čas do biochemické recidivy, dynamika PSA, klinické a případně pooperační stadium onemocnění a grading určit, zda se jedná o lokální či vzdálenou recidivu onemocnění. Podle toho je následně vedena další léčebná strategie.

Terapeutic options with curative intent in prostate cancer include radical prostatectomy and radiotherapy. In many patients, rising PSA after completing the local therapy is detected and this is a marker of disease persistence. This PSA increase is often the only evidence of cancer relaps which usually preceeds clinical manifestation by months or years. Based on parameters such time to biochemical relaps, PSA kinetics, clinical or even patological features (staging, grading), the physician has to differ, whether local or systemic relaps occurs. Regarding to the type of relaps, further treatment is indicated.

• Keywords
• selhání léčby, salvage terapie, PSA,
• MeSH
• Biochemistry MeSH
• Brachytherapy MeSH
• Diagnostic Techniques, Urological MeSH
• Cryotherapy MeSH
• Humans MeSH
• Neoplasm Metastasis diagnosis   prevention & control   radiotherapy   MeSH
• Prostatic Neoplasms prevention & control   radiotherapy   secondary   MeSH
• Survival MeSH
• Disease Progression MeSH
• Prostatectomy MeSH
• Prostate-Specific Antigen analysis   MeSH
• Radiotherapy MeSH
• Randomized Controlled Trials as Topic MeSH
• Recurrence MeSH
• Secondary Prevention MeSH
• Treatment Outcome MeSH
• Salvage Therapy methods   utilization   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Review MeSH

Cíl: Magnetická rezonance (MR) představuje v současné době vhodnou diagnostickou metodu k přesnějšímu stanovení lokálního rozsahu nádorového onemocnění, zejména při využití zobrazení magnetickou rezonancí (MRI) a magnetické rezonanční spektroskopie (MRS). Přinášíme vlastní zkušenosti s použitím MRS a MRI při detekci nádoru prostaty. Metody a výsledky: V práci jsou uvedeny naše zkušenosti s použitím MRS a MRI v souboru nemocných s ověřeným karcinomem prostaty (CaP) a indikovaných k radikální prostatektomii (RP). Srovnáváme výsledky definitivního histologického preparátu s výsledky MR. Průměrný věk nemocných v tomto souboru byl 64,4 roků (52 až 70 let), průměrná hodnota prostata specifického antigenu (PSA) 8,37 µg/l (1,5 až 28,5 µg/l). Shoda nálezů MR a histologického nálezu byla zaznamenána ve 27 případech (73 %) se senzitivitou 76% a specificitou 80%. Další soubor tvoří nemocní s negativním histologickým nálezem a přetrvávající elevací PSA, kteří byli vyšetření na MR. Shoda nálezů MR a histologického nálezu biopsie prostaty byla nalezena u 14 nemocných (61 %), neshodné nálezy pak u devíti nemocných (31 %). CaP byl diagnostikován pouze u pěti nemocných. Posledním souborem jsou nemocní po radikální prostat-ektomii s chemickou elevací PSA, kteří byli vyšetřeni MR s cílem prokázat lokální recidivu onemocnění po RR MR nezaznamenala podezření na lokální recidivu onemocnění a také následné cílené bioptické vyšetření nepotvrdilo recidivu onemocnění. Závěr: MRI a MRS jsou dle našich dosavadních poznatků vhodnou metodou pro posouzení lokálního rozsahu nádoru prostaty. Naopak naše výsledky zatím nepotvrzují možnost detekce lokální recidivy po RP a možnost ověření CaP při opakované negativní biopsii prostaty a přetrvávající elevaci PSA.

Aim: Magnetic resonance (MRI) presently represents an eligible diagnostic method for more precise determination of local extension of prostate cancer status using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). In our work we present our own experience with MRI and MRS in the detection of prostate cancer. Methods and results: We present our experience in MRI and MRS in the group of patiens with previously diagnosed prostate cancer (CaP) referred for radical prostatectomy. Histopathologic findings in radical prostatectomy (RP) specimens were compared to MRI results. The average age in the group was 64.4 years (from 52 to 70 years) and the average prostatic specific antigen (PSA) value was 8.37 µg/l (from 1.5 to 28.5 µg/l). Correspondence in tumor stage definition was found in 27 (73%) cases, which means 76% sensitivity and 80% specificity. In the second group we investigated on MR 23 patients with previously negative histopathologic findings on prostate biopsy and persisting PSA elevation. Correspondence in MR findings and prostate biopsy was found in 14 patients (61%). Discrepancy in MR and biopsy findings was in 9 patients (39%). Prostate cancer was diagnosed only in 5 patients. In 5 patients with PSA elevation after RP we expected MR examination to confirm the local recurrence after RP. However MRI and MRS have not brought suspicion of local recurrence of the disease and later histopathologic investigation of specimens obtained by focused biopsy has not confirmed disease recurrence. Conclusion: MRI and MRS are according to our opinion suitable methods for the assessment of local extension of prostate neoplasm. On the other hand our results so far do not confirm the possibility of detecting local recurrence after RP and the possibility of verificating prostate cancer with repeateadly negative prostate biopsies and continuing elevation of PSA level.

• MeSH
• Humans MeSH
• Magnetic Resonance Spectroscopy methods   instrumentation   MeSH
• Magnetic Resonance Imaging contraindications   instrumentation   utilization   MeSH
• Prostatic Neoplasms MeSH
• Sensitivity and Specificity MeSH
• Neoplasm Staging instrumentation   MeSH
• Check Tag
• Humans MeSH
• Male MeSH

Zobrazovací metoda pozitronové tomografie s výpočetní tomografií (positron emission tomography / computed tomography, PET/CT) s využitím prostatického specifického membránového antigenu (prostate-specific membrane antigen, PSMA), PSMA PET/CT, představuje zásadní pokrok v diagnostice a léčbě karcinomu prostaty. V oblasti diagnostiky nabízí výrazně vyšší senzitivitu a specificitu oproti konvenčním metodám, zejména při primárním stagingu, perzistenci prostatického specifického antigenu (PSA) po radikální prostatektomii a biochemickém relapsu po radikální léčbě. Stále častěji se uplatňuje i v rámci teranostiky, tedy propojení diagnostiky a cílené radionuklidové terapie u pacientů s metastazujícím kastračně rezistentním karcinomem prostaty. Klinické studie fáze III (např. VISION, TheraP, PSMAfore) prokázaly významný přínos PSMA značeného luteciem-177 (177Lu-PSMA-617) z hlediska přežití i kvality života ve srovnání s jinými léčebnými možnostmi. Využití PSMA PET/CT tak výrazně přispívá k personalizovanému přístupu k pacientům a mění zavedené algoritmy diagnostiky a léčby karcinomu prostaty.

The imaging modality prostate specific membrane antigen positron emission tomography / computed tomography (PSMA PET/CT) represents a major advancement in the diagnosis and treatment of prostate cancer. In diagnostics, it offers significantly higher sensitivity and specificity compared to conventional methods, particularly in primary staging, persistent prostate specific antigen (PSA) following radical prostatectomy, and biochemical recurrence after radical treatment. It is increasingly utilized in theranostics, which combines diagnostic imaging with targeted radionuclide therapy in patients with metastatic castration-resistant prostate cancer. Phase III clinical trials (e.g. VISION, TheraP, PSMAfore) have demonstrated a significant benefit of 177Lu-PSMA-617 in terms of survival and quality of life compared to other treatment options. The use of PSMA PET/CT thus contributes substantially to personalized patient care and is reshaping established diagnostic and therapeutic algorithms in prostate cancer management.

CONTEXT: The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown. OBJECTIVE: To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa. EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed. EVIDENCE SYNTHESIS: Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains. CONCLUSIONS: Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed. PATIENT SUMMARY: We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.

• MeSH
• Surgeons supply & distribution   MeSH
• Outcome Assessment, Health Care MeSH
• Humans MeSH
• Neoplasm Recurrence, Local MeSH
• Prostatic Neoplasms surgery   MeSH
• Hospitals MeSH
• Delivery of Health Care standards   MeSH
• Workload MeSH
• Prostate surgery   MeSH
• Prostatectomy adverse effects   MeSH
• Hospitals, High-Volume MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Systematic Review MeSH