Delayed radical prostatectomy for intermediate‐risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database. Issue 4 (19th September 2012)

• Record Type: Journal Article
• Authors: Abern, Michael R.; Aronson, William J.; Terris, Martha K.; Kane, Christopher J.; Presti, Joseph C.; Amling, Christopher L.; Freedland, Stephen J.
• Is Part Of: Prostate. Volume 73:Issue 4(2013)
• Page Start: 409
• Page End: 417
• Publication Date: 2012-09-19
• Subjects: Prostate -- Diseases -- Periodicals; 616
• DOI: 10.1002/pros.22582
• Languages: English
• ISSNs: 0270-4137

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>INTRODUCTION</title> <p>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.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>METHODS</title> <p>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.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>RESULTS</title> <p>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 <italic>P</italic> > 0.05). For intermediate‐risk men, however, delays >9 months were significantly related to BCR (HR: 2.10, <italic>P</italic> = 0.01) and PSM (OR: 4.08, <italic>P</italic> < 0.01). Delays >9 months were associated with BCR in subsets of intermediate‐risk men with biopsy Gleason score ≤3 + 4 (HR: 2.51, <italic>P</italic> < 0.01), PSA ≤ 6 (HR: 2.82, <italic>P</italic> = 0.06), and low tumor volume (HR: 2.59, <italic>P</italic> = 0.06).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>CONCLUSIONS</title> <p>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. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>