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Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database.

Publication ,  Journal Article
Abern, MR; Aronson, WJ; Terris, MK; Kane, CJ; Presti, JC; Amling, CL; Freedland, SJ
Published in: Prostate
March 2013

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.

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Published In

Prostate

DOI

EISSN

1097-0045

Publication Date

March 2013

Volume

73

Issue

4

Start / End Page

409 / 417

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Humans
 

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Abern, M. R., Aronson, W. J., Terris, M. K., Kane, C. J., Presti, J. C., Amling, C. L., & Freedland, S. J. (2013). Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database. Prostate, 73(4), 409–417. https://doi.org/10.1002/pros.22582
Abern, Michael R., William J. Aronson, Martha K. Terris, Christopher J. Kane, Joseph C. Presti, Christopher L. Amling, and Stephen J. Freedland. “Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database.Prostate 73, no. 4 (March 2013): 409–17. https://doi.org/10.1002/pros.22582.
Journal cover image

Published In

Prostate

DOI

EISSN

1097-0045

Publication Date

March 2013

Volume

73

Issue

4

Start / End Page

409 / 417

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Humans