Delayed radical prostatectomy for intermediate‐risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database
- 19 September 2012
- journal article
- research article
- Published by Wiley in The Prostate
- Vol. 73 (4), 409-417
- https://doi.org/10.1002/pros.22582
Abstract
INTRODUCTION Active surveillance (AS) is increasingly accepted as appropriate management for low-risk prostate cancer (PC) patients. It is unknown whether delaying radical prostatectomy (RP) is associated with increased risk of biochemical recurrence (BCR) for men with intermediate-risk PC. METHODS We performed a retrospective analysis of 1,561 low and intermediate-risk men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with RP between 1988 and 2011. Patients were stratified by interval between diagnosis and RP (≤3, 3–6, 6–9, or >9 months) and by risk using the D'Amico classification. Cox proportional hazard models were used to analyze BCR. Logistic regression was used to analyze positive surgical margins (PSM), extracapsular extension (ECE), and pathologic upgrading. RESULTS Overall, 813 (52%) men were low-risk, and 748 (48%) intermediate-risk. Median follow-up among men without recurrence was 52.9 months, during which 437 men (38.9%) recurred. For low-risk men, RP delays were unrelated to BCR, ECE, PSM, or upgrading (all P > 0.05). For intermediate-risk men, however, delays >9 months were significantly related to BCR (HR: 2.10, P = 0.01) and PSM (OR: 4.08, P < 0.01). Delays >9 months were associated with BCR in subsets of intermediate-risk men with biopsy Gleason score ≤3 + 4 (HR: 2.51, P < 0.01), PSA ≤ 6 (HR: 2.82, P = 0.06), and low tumor volume (HR: 2.59, P = 0.06). CONCLUSIONS For low-risk men, delayed RP did not significantly affect outcome. For men with intermediate-risk disease, delays >9 months predicted greater BCR and PSM risk. If confirmed in future studies, this suggests delayed RP for intermediate-risk PC may compromise outcomes. Prostate 73: 409–417, 2013.Keywords
This publication has 27 references indexed in Scilit:
- Underestimation of Gleason score at prostate biopsy reflects sampling error in lower volume tumoursBJU International, 2011
- Active Surveillance Program for Prostate Cancer: An Update of the Johns Hopkins ExperienceJournal of Clinical Oncology, 2011
- The implementation of screening for prostate cancerProstate Cancer and Prostatic Diseases, 2010
- Prostate Cancer Death of Men Treated With Initial Active Surveillance: Clinical and Biochemical CharacteristicsJournal of Urology, 2010
- Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA rangeProstate Cancer and Prostatic Diseases, 2009
- A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate CancerJournal of Urology, 2009
- Pathological Upgrading and Up Staging With Immediate Repeat Biopsy in Patients Eligible for Active SurveillanceJournal of Urology, 2008
- Contemporary Evaluation of the D’Amico Risk Classification of Prostate CancerUrology, 2007
- Upgrading and Downgrading of Prostate Needle Biopsy Specimens: Risk Factors and Clinical ImplicationsUrology, 2007
- Interval from prostate biopsy to radical prostatectomy: Effect on PSA, Gleason sum, and risk of recurrenceUrology, 2005