Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer

Stephen J. Freedland, Christopher J. Kane, Christopher L. Amling, William J. Aronson, Joseph C. Presti, Martha Kennedy Terris

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Purpose: Men newly diagnosed with prostate cancer are faced with multiple treatment options. Understanding these options and their associated side effects, and making a decision often requires time, resulting in a delay before receiving treatment. This is particularly pertinent in men with low risk disease who may be considered candidates for watchful waiting and, thus, may not experience strong pressure to undergo treatment promptly. Whether delays and especially prolonged delays, eg greater than 180 days, before RP negatively impact the disease outcome is unclear. Materials and Methods: We examined the association between time from diagnosis to surgery, and pathological features of the RP specimen and risk of biochemical progression in 895 men with low risk prostate cancer (prostate specific antigen less than 10 ng/ml and biopsy Gleason sum 6 or less) treated with RP between 1988 and 2004 in the Shared-Equal Access Regional Cancer Hospital Database using logistic regression and Cox proportional hazards, respectively. Results: Time from biopsy to surgery was not significantly related to high grade disease in the RP specimen, positive surgical margins or extraprostatic extension (all p-trend >0.05). After adjustment for multiple clinical covariates a longer time from biopsy to surgery was significantly associated with an increased risk of biochemical progression (p-trend = 0.002). However, this increased risk of progression was only apparent in men with delays greater than 180 days (median 263, vs 90 or fewer days RR 2.73, 95% CI 1.51 to 4.94). Conclusions: Our data suggest that patients with low risk prostate cancer can be reassured that immediate treatment is not necessary. Whether long delays (greater than 180 days) decrease the likelihood of curability in some patients requires further study.

Original languageEnglish (US)
Pages (from-to)1298-1303
Number of pages6
JournalJournal of Urology
Volume175
Issue number4
DOIs
StatePublished - Jan 1 2006

Fingerprint

Prostatectomy
Prostatic Neoplasms
Biopsy
Watchful Waiting
Cancer Care Facilities
Therapeutics
Prostate-Specific Antigen
Decision Making
Logistic Models
Databases
Pressure

Keywords

  • Biopsy
  • Prostate
  • Prostate-specific antigen
  • Prostatectomy
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer. / Freedland, Stephen J.; Kane, Christopher J.; Amling, Christopher L.; Aronson, William J.; Presti, Joseph C.; Terris, Martha Kennedy.

In: Journal of Urology, Vol. 175, No. 4, 01.01.2006, p. 1298-1303.

Research output: Contribution to journalArticle

Freedland, Stephen J. ; Kane, Christopher J. ; Amling, Christopher L. ; Aronson, William J. ; Presti, Joseph C. ; Terris, Martha Kennedy. / Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer. In: Journal of Urology. 2006 ; Vol. 175, No. 4. pp. 1298-1303.
@article{66db9c3f30744e47b04f4e158b14c94a,
title = "Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer",
abstract = "Purpose: Men newly diagnosed with prostate cancer are faced with multiple treatment options. Understanding these options and their associated side effects, and making a decision often requires time, resulting in a delay before receiving treatment. This is particularly pertinent in men with low risk disease who may be considered candidates for watchful waiting and, thus, may not experience strong pressure to undergo treatment promptly. Whether delays and especially prolonged delays, eg greater than 180 days, before RP negatively impact the disease outcome is unclear. Materials and Methods: We examined the association between time from diagnosis to surgery, and pathological features of the RP specimen and risk of biochemical progression in 895 men with low risk prostate cancer (prostate specific antigen less than 10 ng/ml and biopsy Gleason sum 6 or less) treated with RP between 1988 and 2004 in the Shared-Equal Access Regional Cancer Hospital Database using logistic regression and Cox proportional hazards, respectively. Results: Time from biopsy to surgery was not significantly related to high grade disease in the RP specimen, positive surgical margins or extraprostatic extension (all p-trend >0.05). After adjustment for multiple clinical covariates a longer time from biopsy to surgery was significantly associated with an increased risk of biochemical progression (p-trend = 0.002). However, this increased risk of progression was only apparent in men with delays greater than 180 days (median 263, vs 90 or fewer days RR 2.73, 95{\%} CI 1.51 to 4.94). Conclusions: Our data suggest that patients with low risk prostate cancer can be reassured that immediate treatment is not necessary. Whether long delays (greater than 180 days) decrease the likelihood of curability in some patients requires further study.",
keywords = "Biopsy, Prostate, Prostate-specific antigen, Prostatectomy, Prostatic neoplasms",
author = "Freedland, {Stephen J.} and Kane, {Christopher J.} and Amling, {Christopher L.} and Aronson, {William J.} and Presti, {Joseph C.} and Terris, {Martha Kennedy}",
year = "2006",
month = "1",
day = "1",
doi = "10.1016/S0022-5347(05)00646-4",
language = "English (US)",
volume = "175",
pages = "1298--1303",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer

AU - Freedland, Stephen J.

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Aronson, William J.

AU - Presti, Joseph C.

AU - Terris, Martha Kennedy

PY - 2006/1/1

Y1 - 2006/1/1

N2 - Purpose: Men newly diagnosed with prostate cancer are faced with multiple treatment options. Understanding these options and their associated side effects, and making a decision often requires time, resulting in a delay before receiving treatment. This is particularly pertinent in men with low risk disease who may be considered candidates for watchful waiting and, thus, may not experience strong pressure to undergo treatment promptly. Whether delays and especially prolonged delays, eg greater than 180 days, before RP negatively impact the disease outcome is unclear. Materials and Methods: We examined the association between time from diagnosis to surgery, and pathological features of the RP specimen and risk of biochemical progression in 895 men with low risk prostate cancer (prostate specific antigen less than 10 ng/ml and biopsy Gleason sum 6 or less) treated with RP between 1988 and 2004 in the Shared-Equal Access Regional Cancer Hospital Database using logistic regression and Cox proportional hazards, respectively. Results: Time from biopsy to surgery was not significantly related to high grade disease in the RP specimen, positive surgical margins or extraprostatic extension (all p-trend >0.05). After adjustment for multiple clinical covariates a longer time from biopsy to surgery was significantly associated with an increased risk of biochemical progression (p-trend = 0.002). However, this increased risk of progression was only apparent in men with delays greater than 180 days (median 263, vs 90 or fewer days RR 2.73, 95% CI 1.51 to 4.94). Conclusions: Our data suggest that patients with low risk prostate cancer can be reassured that immediate treatment is not necessary. Whether long delays (greater than 180 days) decrease the likelihood of curability in some patients requires further study.

AB - Purpose: Men newly diagnosed with prostate cancer are faced with multiple treatment options. Understanding these options and their associated side effects, and making a decision often requires time, resulting in a delay before receiving treatment. This is particularly pertinent in men with low risk disease who may be considered candidates for watchful waiting and, thus, may not experience strong pressure to undergo treatment promptly. Whether delays and especially prolonged delays, eg greater than 180 days, before RP negatively impact the disease outcome is unclear. Materials and Methods: We examined the association between time from diagnosis to surgery, and pathological features of the RP specimen and risk of biochemical progression in 895 men with low risk prostate cancer (prostate specific antigen less than 10 ng/ml and biopsy Gleason sum 6 or less) treated with RP between 1988 and 2004 in the Shared-Equal Access Regional Cancer Hospital Database using logistic regression and Cox proportional hazards, respectively. Results: Time from biopsy to surgery was not significantly related to high grade disease in the RP specimen, positive surgical margins or extraprostatic extension (all p-trend >0.05). After adjustment for multiple clinical covariates a longer time from biopsy to surgery was significantly associated with an increased risk of biochemical progression (p-trend = 0.002). However, this increased risk of progression was only apparent in men with delays greater than 180 days (median 263, vs 90 or fewer days RR 2.73, 95% CI 1.51 to 4.94). Conclusions: Our data suggest that patients with low risk prostate cancer can be reassured that immediate treatment is not necessary. Whether long delays (greater than 180 days) decrease the likelihood of curability in some patients requires further study.

KW - Biopsy

KW - Prostate

KW - Prostate-specific antigen

KW - Prostatectomy

KW - Prostatic neoplasms

UR - http://www.scopus.com/inward/record.url?scp=33644583596&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644583596&partnerID=8YFLogxK

U2 - 10.1016/S0022-5347(05)00646-4

DO - 10.1016/S0022-5347(05)00646-4

M3 - Article

C2 - 16515984

AN - SCOPUS:33644583596

VL - 175

SP - 1298

EP - 1303

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 4

ER -