{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T12:49:50Z","timestamp":1764593390055,"version":"3.46.0"},"reference-count":69,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Over the past decade, prostate cancer (PCa) survival rates have increased, largely due to advancements in modern healthcare. As a result, the majority of PCa patients worldwide are now survivors, placing a considerable burden on healthcare systems. Specialists at Miguel Servet Hospital in Zaragoza, Spain, follow the European Association of Urology (EAU) guidelines in managing PCa patients; however, these recommendations do not specifically address the follow\u2010up of patients by nonspecialist medical staff. This study evaluates the safety of a follow\u2010up protocol that refers PCa survivors to primary care after undergoing radical prostatectomy (RP) as a curative treatment, with a particular focus on those diagnosed with pathologic high\u2010grade localized and locally advanced PCa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study includes data from 579 patients diagnosed with high\u2010risk PCa\u2014both localized and locally advanced\u2014according to EAU criteria. These patients underwent RP between 1992 and 2018 at the Arag\u00f3n Health Service (SALUD), Sector Zaragoza II\u2014Hospital Universitario Miguel Servet. The follow\u2010up protocol involves initial monitoring by the urology department. Patients who remain free of biochemical recurrence (BCR) are subsequently followed up by primary care (PC) medical staff. To evaluate the short\u2010 and long\u2010term effectiveness of this protocol, we analyzed biochemical recurrence\u2010free survival, stratified by risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The BCR rate after referral to PC is under 20.5% in the overall high\u2010risk group. A more detailed analysis shows that the localized subgroup has a 14.5% BCR probability, while the locally advanced subgroup experiences a fourfold increase, reaching 41.98%. The risk of BCR is 2\u20135 times higher in the locally advanced group compared to the localized group. BCR patterns indicate that nearly half of all cases occur within 4 years post\u2010RP, though trends vary by risk group. In high\u2010risk localized PCa, almost half of BCRs occur between four and ten years post\u2010RP, whereas in locally advanced PCa, over 65% occur within the first 4 years, indicating earlier recurrence in this group. Kaplan\u2013Meier survival curves confirm a significant difference (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001): locally advanced PCa shows a threefold higher cumulative BCR risk at 10 years (2.78) and a fourfold higher risk at 5 years (4.41). Although the overall BCR rate after referral to PC is below 20.5% in the high\u2010risk group, recurrence risk varies significantly\u201414.5% in the localized subgroup versus 41.98% in the locally advanced subgroup. These findings underscore the earlier and more frequent recurrence in locally advanced PCa compared to high\u2010risk localized PCa.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Referring PCa survivors for follow\u2010up in primary care has proven to be an effective and safe approach. The success of this protocol can be attributed to clear communication with the primary care team regarding the parameters for referring patients back to specialized care for recurrence assessment. As expected, the high\u2010risk localized group showed a lower incidence of BCR than the locally advanced group, consistent with known recurrence patterns. It is imperative that the Spanish healthcare system implement a public primary care program dedicated to cancer survivors, with the aim of reducing the substantial burden on specialized services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70057","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T11:03:42Z","timestamp":1758711822000},"page":"105-115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integration of Primary Care Into the Follow\u2010Up Protocol for Prostate Cancer Patients in Aragon, Spain. It Is Time to Follow Other Successful Models in the Region"],"prefix":"10.1002","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0178-4567","authenticated-orcid":false,"given":"Angel","family":"Borque\u2010Fernando","sequence":"first","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"},{"name":"Arag\u00f3n Health Research Institute (IISA) Zaragoza Spain"},{"name":"Area of Urology, Department of Surgery Faculty of Medicine, University of Zaragoza Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1657-4792","authenticated-orcid":false,"given":"Patricia","family":"Guerrero\u2010Ochoa","sequence":"additional","affiliation":[{"name":"Arag\u00f3n Health Research Institute (IISA) Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3007-302X","authenticated-orcid":false,"given":"Luis Mariano","family":"Esteban","sequence":"additional","affiliation":[{"name":"Escuela Universitaria Polit\u00e9cnica de La Almunia, University of Zaragoza Zaragoza Spain"},{"name":"Institute for Biocomputation and Physics of Complex systems Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4420-7567","authenticated-orcid":false,"given":"Aitor","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Statistical methods University of Zaragoza Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1909-9931","authenticated-orcid":false,"given":"Ra\u00fal","family":"L\u00f3pez\u2010Blasco","sequence":"additional","affiliation":[{"name":"Biocomputing Unit, Aragon Health Sciences Institute (IACS) Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0435-9664","authenticated-orcid":false,"given":"Raquel Esp\u00edlez","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7722-6871","authenticated-orcid":false,"given":"Pedro Gil","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5629-7646","authenticated-orcid":false,"given":"Jes\u00fas","family":"Gil\u2010Fabra","sequence":"additional","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0490-5635","authenticated-orcid":false,"given":"Miguel Angel","family":"Trivez\u2010Boned","sequence":"additional","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8527-147X","authenticated-orcid":false,"given":"Eva","family":"Mall\u00e9n\u2010Mateo","sequence":"additional","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0586-8138","authenticated-orcid":false,"given":"Mar\u00eda Jes\u00fas","family":"Gil\u2010Sanz","sequence":"additional","affiliation":[{"name":"Department of Urology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-021-03643-1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.554"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29040218"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2020.101820"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-021-01567-w"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14133166"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.3841"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0154"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41585-022-00638-6"},{"key":"e_1_2_8_11_1","unstructured":"N.Mottet P.Cornford R. 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