Nondetectable Prostate Carcinoma (pT0) after Radical Prostatectomy: A Narrative Review
, Ioannis Katafigiotis 3,5, Marcio Covas Moschovas 6, Henk van der Poel 2 and European Association of Urology (EAU) Young Academic Urologists (YAU) Robotic Urology Working Group †Round 1
Reviewer 1 Report
The authors have done an interestingly narrative review of incidence, predictors, pre-treatment and prognosis of pT0 of prostate cancers on radical prostatectomy specimens. Regarding the search of the literature from medical database, the authors do not provide the number of abstracts being read and discarded as well as the number of full text being read. The authors need to add a flow diagram in the first paragraph of the result section to demonstrate the whole procedure and result (i.e. the number) of searching literature. The authors have categorized pTa studies in 4 domains: incidence, preoperative predictors, previous HT and prognosis/recurrence. The review of each domain is concise and clear and the conclusion is reasonable as well.
Author Response
Thanks for your valuable remarks. A Prisma flow diagram was added.
Reviewer 2 Report
Very well written manuscript. Satisfactory research methodology. constructed very well.
The pT0 occurrence at RP specimens is incredibly rare, and this review gives good insight into the fact that it likely poor patient selection, for those men initially diagnosed with low risk PCa. there is also the higher risk group who received neoadj hormones and the occurrence of pT0 is to occasionally be expected.
I would like the authors to focus more on risk stratification of newly diagnosed PCa. althought the incidence is rare, the vast majority of men with pT0 had PCa that today, should be offered active surveillance. If anything, this manuscript should be focussing more on the risk stratification for men with PCa and appropriate counselling.
Author Response
Thanks for your remarks. We added the following paragraph in paragraph 3.2: "Data from these studies show that the vast majority of men with pT0 had low-risk PCa which today, should be offered active surveillance. Risk stratification of patients is of utmost importance in order to avoid over-treatment and its possible side effects."
The following data were also added in the conclusion: "The findings of our review strengthen the active surveillance strategy in low-risk cases instead of RP. "
