Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence

Possible implications for active surveillance from the SEARCH database

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

Research output: Contribution to journalArticle

50 Citations (Scopus)

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. © 2012 Wiley Periodicals, Inc.

Original languageEnglish (US)
Pages (from-to)409-417
Number of pages9
JournalProstate
Volume73
Issue number4
DOIs
StatePublished - Mar 1 2013

Fingerprint

Cancer Care Facilities
Prostatectomy
Prostatic Neoplasms
Databases
Recurrence
Neoplasm Grading
Risk Management
Proportional Hazards Models
Prostate
Logistic Models

Keywords

  • active surveillance
  • prostatectomy
  • prostatic neoplasms
  • retropubic
  • treatment outcome

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence : Possible implications for active surveillance from the SEARCH database. / Abern, Michael R.; Aronson, William J.; Terris, Martha Kennedy; Kane, Christopher J.; Presti, Joseph C.; Amling, Christopher L.; Freedland, Stephen J.

In: Prostate, Vol. 73, No. 4, 01.03.2013, p. 409-417.

Research output: Contribution to journalArticle

Abern, Michael R. ; Aronson, William J. ; Terris, Martha Kennedy ; Kane, Christopher J. ; Presti, Joseph C. ; Amling, Christopher L. ; Freedland, Stephen J. / Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence : Possible implications for active surveillance from the SEARCH database. In: Prostate. 2013 ; Vol. 73, No. 4. pp. 409-417.
@article{d76e2134529e4fe68b3934864dfe864f,
title = "Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database",
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. {\circledC} 2012 Wiley Periodicals, Inc.",
keywords = "active surveillance, prostatectomy, prostatic neoplasms, retropubic, treatment outcome",
author = "Abern, {Michael R.} and Aronson, {William J.} and Terris, {Martha Kennedy} and Kane, {Christopher J.} and Presti, {Joseph C.} and Amling, {Christopher L.} and Freedland, {Stephen J.}",
year = "2013",
month = "3",
day = "1",
doi = "10.1002/pros.22582",
language = "English (US)",
volume = "73",
pages = "409--417",
journal = "Prostate",
issn = "0270-4137",
publisher = "Wiley-Liss Inc.",
number = "4",

}

TY - JOUR

T1 - Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence

T2 - Possible implications for active surveillance from the SEARCH database

AU - Abern, Michael R.

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Kane, Christopher J.

AU - Presti, Joseph C.

AU - Amling, Christopher L.

AU - Freedland, Stephen J.

PY - 2013/3/1

Y1 - 2013/3/1

N2 - 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. © 2012 Wiley Periodicals, Inc.

AB - 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. © 2012 Wiley Periodicals, Inc.

KW - active surveillance

KW - prostatectomy

KW - prostatic neoplasms

KW - retropubic

KW - treatment outcome

UR - http://www.scopus.com/inward/record.url?scp=84872963407&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872963407&partnerID=8YFLogxK

U2 - 10.1002/pros.22582

DO - 10.1002/pros.22582

M3 - Article

VL - 73

SP - 409

EP - 417

JO - Prostate

JF - Prostate

SN - 0270-4137

IS - 4

ER -