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How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study



Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy.


The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients’ characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND).


The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients.

At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies.


PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium–high risk diagnosed PCa.

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  1. 1.

    Ficarra V, Novara G, Artibani W et al (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55(5):1037–1063.

    Article  PubMed  Google Scholar 

  2. 2.

    Heidenreich A, Aus G, Bolla M et al (2008) European Association of Urology. EAU guidelines on prostate cancer. Eur Urol 53(1):68–80.

    Article  PubMed  Google Scholar 

  3. 3.

    Mottet N, Cornford P. van den Bergh RCN et al (2020) EAU—EANM—ESTRO—ESUR—SIOG Guidelines on Prostate Cancer.

  4. 4.

    Bruendl J, Rothbauer C, Bn L et al (2018) Accordance of online health information on prostate cancer with the European Association of Urology Guidelines. Urol Int 100(3):288–293.

    Article  PubMed  Google Scholar 

  5. 5.

    Simonato A, Varca V, Gacci M et al (2012) Adherence to guidelines among italian urologists on imaging preoperative staging of low-risk prostate cancer: results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study. Adv Urol 2012:651061.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Imbimbo C, Creta M, Gacci M et al (2011) Patients' desire to preserve sexual activity and final decision for a nerve-sparing approach: results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study. J Sex Med 8(5):1495–1502.

    Article  PubMed  Google Scholar 

  7. 7.

    Noale M, Maggi S, Artibani W et al (2017) Pros-IT CNR study group. Pros-IT CNR: an Italian prostate cancer monitoring project. Aging Clin Exp Res 29(2):165–172.

    Article  PubMed  Google Scholar 

  8. 8.

    Apolone G, Mosconi P, Quattrociocchi L et al (2001) Questionario sullo stato di salute SF-12. Versione Italiana. Guerini e Associati Editore, Milano

    Google Scholar 

  9. 9.

    Gacci M, Livi L, Paiar F et al (2005) Quality of life after radical treatment of prostate cancer: validation of the Italian version of the University of California Los Angeles-Prostate Cancer Index. Urology 66:338–343.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Porreca A, Noale M, Artibani W et al (2018) Pros-IT CNR study group. Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: the Pros-IT CNR study. Health Qual Life Outcomes 16(1):122.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Gacci M, Noale M, Artibani W et al (2017) Pros-IT CNR study group. Quality of life after prostate cancer diagnosis: data from the Pros-IT CNR. Eur Urol Focus 3(4–5):321–324.

    Article  PubMed  Google Scholar 

  12. 12.

    Leow JJ, Chang SL, Meyer CP et al (2016) Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol 70(5):837–845.

    Article  PubMed  Google Scholar 

  13. 13.

    D’Amico AV (2011) Risk-based management of prostate cancer. N Engl J Med 365(2):169–171.

    Article  PubMed  Google Scholar 

  14. 14.

    Vignolini G, Campi R, Sessa F et al (2019) Development of a robot-assisted kidney transplantation programme from deceased donors in a referral academic centre: technical nuances and preliminary results. BJU Int 123(3):474–484.

    Article  PubMed  Google Scholar 

  15. 15.

    Vignolini G, Sessa F, Greco I et al (2019) Intraoperative assessment of ureteral and graft reperfusion during robotic kidney transplantation with indocyanine green fluorescence videography. Minerva Urol Nefrol 71(1):79–84.

    Article  PubMed  Google Scholar 

  16. 16.

    Mearini L, Gacci M, Saleh O et al (2014) Multicenter Italian Report on Radical Prostatectomy: Outcome and Research (MIRROR) Project-Leading Urological No-Profit Foundation for Advanced Research (LUNA) Foundation. External validation of nomogram predicting the probability of specimen-confined disease (pT2-3a, R0N0) in patients undergoing radical prostatectomy and pelvic lymph node dissection. Urol Int 93(3):262–268.

    Article  PubMed  Google Scholar 

  17. 17.

    Gacci M, Schiavina R, Lanciotti M et al (2013) External validation of the updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection. Urol Int 90(3):277–282.

    Article  PubMed  Google Scholar 

  18. 18.

    Briganti A, Larcher A, Abdollah F et al (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61(3):480–487.

    Article  PubMed  Google Scholar 

  19. 19.

    De Nunzio C, Lombardo R, Tema G et al (2018) External validation of Chun, PCPT, ERSPC, Kawakami, and Karakiewicz nomograms in the prediction of prostate cancer: a single center cohort-study. Urol Oncol 36(8):364.e1–364.e7.

    Article  Google Scholar 

  20. 20.

    Briganti A, Joniau S, Gontero P et al (2012) Identifying the best candidate for radical prostatectomy among patients with high-risk prostate cancer. Eur Urol 61(3):584–592.

    Article  PubMed  Google Scholar 

  21. 21.

    Schiffmann J, Haese A, Leyh-Bannurah SR et al (2015) Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: differences between open and robot-assisted radical prostatectomy. Eur J Surg Oncol 41(11):1547–1553.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Fütterer JJ, Briganti A, De Visschere P et al (2015) Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 68(6):1045–1053.

    Article  PubMed  Google Scholar 

  23. 23.

    Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378(19):1767–1777.

    Article  PubMed  Google Scholar 

  24. 24.

    Porpiglia F, Bertolo R, Checcucci E et al (2018) ESUT Research Group. Development and validation of 3D printed virtual models for robot-assisted radical prostatectomy and partial nephrectomy: urologists' and patients' perception. World J Urol 36(2):201–207.

    Article  PubMed  Google Scholar 

  25. 25.

    Leyh-Bannurah SR, Budäus L, Zaffuto E et al (2018) Adherence to pelvic lymph node dissection recommendations according to the National Comprehensive Cancer Network pelvic lymph node dissection guideline and the D'Amico lymph node invasion risk stratification. Urol Oncol 36(2):81.e17–81.e24.

    Article  Google Scholar 

  26. 26.

    Porreca A, Noale M, Artibani W et al (2018) Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: the Pros-IT CNR study. Health Qual Life Outcomes 16(1):122.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Gacci M, Carini M, Simonato A et al (2011) Factors predicting continence recovery 1 month after radical prostatectomy: results of a multicenter survey. Int J Urol 18(10):700–708.

    Article  PubMed  Google Scholar 

  28. 28.

    Gacci M, Simonato A, Masieri L et al (2009) Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Health Qual Life Outcomes 13(7):94.

    Article  Google Scholar 

  29. 29.

    Limani K, Albisinni S, Aoun F et al (2017) Quality of life after robotic prostatectomy: Impact of BMI and age on urinary incontinence. Prog Urol 27(4):244–252.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Schiffmann J, Salomon G, Tilki D et al (2017) Radical prostatectomy neutralizes obesity-driven risk of prostate cancer progression. Urol Oncol 35(5):243–249.

    Article  PubMed  Google Scholar 

  31. 31.

    Valerio M, Cerantola Y, Eggener SE et al (2017) New and established technology in focal ablation of the prostate: a systematic review. Eur Urol 71(1):17–34.

    Article  PubMed  Google Scholar 

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Pros-IT CNR is a non-profit observational study. Takeda Italia S.p.A. will furnish CNR with a non-conditional grant to cover the cost of developing a web platform for data entry and the travel expenses of the Steering Committee, the Working Group and the Scientific Committee. The MIRROR study was promoted by Leading Urological No profit foundation Advanced research (LUNA), the research foundation of the Italian Urological Association (SIU) which supported the study with an unrestricted grant. The Pros-IT CNR Group: Steering Committee: Walter Artibani, Pierfrancesco Bassi, Sergio Bracarda, Giario Natale Conti, Renzo Corvò, Gaetano Crepaldi, Angelo Porreca, Pierpaolo Graziotti, Stefania Maggi, Vincenzo Mirone, Rodolfo Montironi, Marianna Noale, Elvio Russi. Scientific Committee: Filippo Bertoni, Mauro Gacci, Stefano Maria Magrini, Giovanni Muto, Stefano Pecoraro, Umberto Ricardi, Andrea Tubaro, Vittorina Zagonel. Working Group: Anna Rita Alitto, Enrica Ambrosi, Alessandro Antonelli, Cynthia Aristei, Franco Bardari, Lilia Bardoscia, Salvina Barra, Sara Bartoncini, Umberto Basso, Carlotta Becherini, Rita Bellavita, Franco Bergamaschi, Stefania Berlingheri, Alfredo Berruti, Marco Borghesi, Roberto Bortolus, Valentina Borzillo, Davide Bosetti, Giuseppe Bove, Pierluigi Bove, Maurizio Brausi, Alessio Bruni, Giorgio Bruno, Eugenio Brunocilla, Alberto Buffoli, Michela Buglione, Consuelo Buttigliero, Giovanni Cacciamani, Michela Caldiroli, Giuseppe Cardo, Giorgio Carmignani, Giuseppe Carrieri, Emanuele Castelli, Elisabetta Castrezzati, Gianpiero Catalano, Susanna Cattarino, Francesco Catucci, Dario Cavallini Francolini, Ofelia Ceccarini, Antonio Celia, Francesco Chiancone, Tommaso Chini, Claudia Cianci, Antonio Cisternino, Devis Collura, Franco Corbella, Matteo Corinti, Paolo Corsi, Fiorenza Cortese, Luigi Corti, Nunzio de Cosimo, Olga Cristiano, D’Angelillo Rolando, Luigi Da Pozzo, Daniele D'Agostino, Carolina D'Elia, Matteo Dandrea, Micheles De Angelis, Paolo De Angelis, Ottavio De Cobelli, Bernardino De Concilio, Antonello De Lisa, Stefano De Luca, Agostina De Stefani, Chiara Lucrezia Deantoni, Claudio Degli Esposti, Anna Destito, Beatrice Detti, Nadia Di Muzio, Andrea Di Stasio, Calogero Di Stefano, Danilo Di Trapani, Giuseppe Difino, Sara Falivene, Giuseppe Farullo, Paolo Fedelini, Ilaria Ferrari, Francesco Ferraù, Matteo Ferro, Andrei Fodor, Francesco Fontana, Francesco Francesca, Giulio Francolini, Paolo Frata, Giovanni Frezza, Pietro Gabriele, Maria Galeandro, Elisabetta Garibaldi, Pietro Giovanni Gennari, Alessandro Gentilucci, Alessandro Giacobbe, Laura Giussani, Giuseppe Giusti, Paolo Gontero, Alessia Guarneri, Cesare Guida, Alberto Gurioli, Dorijan Huqi, Ciro Imbimbo, Gianluca Ingrosso, Cinzia Iotti, Corrado Italia, Pierdaniele La Mattina, Roberto La Rocca, Enza Lamanna, Luciana Lastrucci, Grazia Lazzari, Fabiola Liberale, Giovanni Liguori, Roberto Lisi, Frank Lohr, Riccardo Lombardo, Jon AJ Lovisolo, Giuseppe Mario Ludovico, Nicola Macchione, Francesca Maggio, Michele Malizia, Gianluca Manasse, Giovanni Mandoliti, Giovanna Mantini, Luigi Marafioti, Luisa Marciello, Alberto Mario Marconi, Antonietta Martilotta, Salvino Marzano, Stefano Masciullo, Gloria Maso, Adele Massenzo, Ercole Mazzeo, Luigi Mearini, Serena Medoro, Rosa Molè, Giorgio Monesi, Emanuele Montanari, Franco Montefiore, Giampaolo Montesi, Giuseppe Morgia, Gregorio Moro, Giorgio Muscas, Daniela Musio, Paolo Muto, Giovanni Muzzonigro, Giorgio Napodano, Carlo Luigi Augusto Negro, Mattia Nidini, Maria Ntreta, Marco Orsatti, Carmela Palazzolo, Isabella Palumbo, Alessandro Parisi, Paolo Parma, Nicola Pavan, Martina Pericolini, Francesco Pinto, Antonio Pistone, Valerio Pizzuti, Angelo Platania, Caterina Polli, Giorgio Pomara, Elisabetta Ponti, Antonio Benito Porcaro, Francesco Porpiglia, Dario Pugliese, Armin Pycha, Giuseppe Raguso, Andrea Rampini, Donato Franco Randone, Valentina Roboldi, Marco Roscigno, Maria Paola Ruggieri, Giuseppe Ruoppo, Roberto Sanseverino, Anna Santacaterina, Michele Santarsieri, Riccardo Santoni, Sarah Scagliarini, Giorgio Vittorio Scagliotti, Mauro Scanzi, Marcello Scarcia, Riccardo Schiavina, Alessandro Sciarra, Carmine Sciorio, Tindaro Scolaro, Salvatore Scuzzarella, Oscar Selvaggio, Armando Serao, Sergio Serni, Marco Andrea Signor, Mauro Silvani, Giovanni Silvano, Franco Silvestris, Claudio Simeone, Valeria Simone, Girolamo Spagnoletti, Matteo Giulio Spinelli, Luigi Squillace, Vincenzo Tombolini, Mariastella Toninelli, Luca Triggiani, Alberto Trinchieri, Luca Trodella, Eolo Luca, Lucio Trodella, Carlo Trombetta, Lidia Tronnolone, Marcello Tucci, Daniele Urzì, Riccardo Valdagni, Maurizio Valeriani, Maurizio Vanoli, Elisabetta Vitali, Alessandro Volpe, Stefano Zaramella, Guglielmo Zeccolini, Giampaolo Zini. The MIRROR-SIU/LUNA Group: Ferdinando Acanfora, Ernesto Aiello, Simonato Alchiede, Vincenzo Altieri, Claudio Anceschi, Francesco Aragona, Walter Artibani, Filippo Balloni, Ezio Barasolo, Giuseppe Barba, Riccardo Bartoletti, Pierfrancesco Bassi, Barbara Bigazzi, Emanuele Belgrano, Siracusano Salvatore, Michele Battaglia, Luca Bellei, Attilio Bettin, Giampaolo Bianchi, Leonardo Bombieri, Tommaso Brancato, Guglielmo Breda, Alberto Briganti, Sergio Caggiano, Antonino Calabrò, Michela Caldironi, Biagio Campo, Sergio Capobianco, Francesco Capparelli, Antonio Carbone, Daniele Carlo, Giorgio Carmignani, Giuseppe Catalano, Francesco Catanzaro, Francesco Ciaraldi, Virgilio Cicalese, Antono Cisternino, Carlo Corbu, Sergio Cosciani Cunico, Vincenzo Cosentino, Aldo Crimi, Giuseppina Cucchiarale, Daniele Cuscunà, Rocco Damiano, Massimino D'Armiento, Ottavio De Cobelli, Carlo De Dominicis, Gaetano De Grande, Carlo Del Boca, Angelo D'Elia, Antonello De Lisa, Stefano De Luca, Emmanuel De Mayo, Michele De Martin, Luigi Di Clemente, Sergio Di Meo, Giovanni Di Monaco, Giuliano Di Nicola, Alessandro Di Silverio, Franco Di Silverio, Franco Fabri, Mario Falsaperla, Franco Fanciullacci, Giovanni Ferrari, Gaspare Fiaccavento, Antonio Filoni, Dario Fontana, Gabriele Fontana, Hassan Ghabin, Bruno Frea, Franco Gaboardi, Mauro Gacci, Vincenzo Gentile, Marco Giandotti, Paolo Gontero, Marco Grasso, Gaetano Grosso, Stefano Guazzieri, Antonino Isaia, Giuseppe Landi, Roberto Landolfi, Piero Larcher, Cesare Laurenti, Dino Lavelli, Gianni Lorenzo Leidi, Antonino Lembo, Sergio Leoni, Giuseppe Mario Ludovico, Nicola Maffei, Massimo Maffezzini, Carlo Martinengo, Carlo Manieri, Alberto Mario Marconi, Giuseppe Martorana, Rosaria Mazza, Mauro Medica, Darwin Melloni, Lucio Miano, Emanuele Micheli, Raffaella Milesi, Mauro Silvano Minervini, Danilo Minocci, Vincenzo Mirone, Angelo Molon, Emanuele Montanari, Patrizia Morello, Giuseppe Morgia, Mario Motta, Giovanni Muzzonigro, Federico Narcisi, Giulio Nicita, Salvatore Palermo, Mauro Paoluzzi, Paolo Parma, Paolo Pompa, Massimo Porena, Giovanni Raciti, Donato Franco Randone, Antonio Rizzotto, Francesco Rocco, Michele Romano, Leonardo Rossini, Gian Rosario Russo, Roberto Salvioni, Sandro Sandri, Gianfranco Savoca, Cesare Selli, Francesco Paolo Selvaggi, Fabio Sercia, Carlo Tallarigo, Marco Tanello, Andrea Tasca, Raffaello Tenaglia, Mario Tensi, Carlo Terrone, Luigi Tralce, Alberto Trinchieri, Alessandra Vagge, Primo Valenti, Marco Varaldo, Giuseppe Vespasiani, Carlo Vicentini, Francesco Vicirca, Paolo Viganò, Vincenzo Zaccone, Camil Zartar.


Takeda, LUNA foundation.

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MG project development, manuscript writing. WA data collection. PB data collection. FB data collection. SB data collection. AB data collection. GC data collection. LC data collection. GC data collection. RC data collection. CDN data collection. FF data collection. PG data collection. IG manuscript writing. SM statistical analysis. SMM data collection. VM data collection. RM data collection. GM data collection. GM data collection. MN data analysis, manuscript writing. SP data collection. AP data collection. UR data collection. ER data collection. GR data collection. AS data collection. AS data collection. SS data collection. DT data collection. AT data collection. VZ data collection. GC data collection. MIRROR-SIU/LUNA Study Group: data collection. Pros-IT CNR Study Group: data collection.

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Correspondence to Mauro Gacci.

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All researches involving human participants were in accordance with the principles of the Declaration of Helsinki and were approved by the Ethic Committee of both coordinating centers and of each participating center.

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Informed consent was obtained from all individual participants included in the study.

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Pros-IT CNR data are available only to the collaborating scientists within the study.

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Members of The MIRROR-SIU/LUNA Study Group and the Pros-IT CNR Study Group are listed in Acknowledgements section.

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Gacci, M., Artibani, W., Bassi, P. et al. How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study. World J Urol 39, 1445–1452 (2021).

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  • Prostate cancer
  • Pros-IT CNR study
  • Robotic procedures
  • Nerve sparing
  • Lymph node dissection