Outcomes after radical prostatectomy among men who are candidates for active surveillance: Results from the SEARCH database

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

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Abstract

Objective: We sought to evaluate outcomes after radical prostatectomy among men with low-risk prostate cancer who would be candidates for active surveillance. Methods: Using the Shared Equal Access Regional Cancer Hospital (SEARCH) database of men treated with radical prostatectomy at multiple equal-access medical centers between 1988 and 2007, 398 of 2062 men (19%) met our criteria for potential active surveillance: clinical stage T1c or T2a, prostate-specific antigen (PSA) <10 ng/mL, Gleason sum ≤6, and no more than 1 or 2 positive cores on at least a sextant biopsy. We examined the risk of adverse pathology, biochemical progression, and PSA doubling time (PSADT) at the time of recurrence. We used a Cox proportional hazards model to determine the significant predictors of PSA progression. Results: Of the men with low-risk prostate cancer, 85% had organ-confined disease, only 2% had seminal vesicle invasion, and no patient had lymph node metastasis. The 5- and 10 year PSA-free survival rates were 81% (95% CI: 76-86%) and 66% (95% CI: 54-76%). On multivariate analysis, older age (P = .005), Agent Orange exposure (P = .02), and obesity (P = .03) were all significantly associated with biochemical failure. Mean and median PSADT among men who experienced recurrence were 37 and 20 months. Only 3 patients experienced recurrence with PSADT < 9 months. Conclusions: Most men with low-risk prostate cancer treated with radical prostatectomy experience long-term PSA control. Those who did experience recurrence often did so with a long PSADT. Consistent with prior SEARCH database reports, older age, Agent Orange exposure, and obesity increased the risk of recurrence.

Original languageEnglish (US)
Pages (from-to)695-700
Number of pages6
JournalUrology
Volume76
Issue number3
DOIs
StatePublished - Sep 1 2010

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Cancer Care Facilities
Prostatectomy
Prostate-Specific Antigen
Databases
Recurrence
Prostatic Neoplasms
Obesity
Seminal Vesicles
Proportional Hazards Models
Multivariate Analysis
Survival Rate
Lymph Nodes
Pathology
Neoplasm Metastasis
Biopsy

ASJC Scopus subject areas

  • Urology

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Outcomes after radical prostatectomy among men who are candidates for active surveillance : Results from the SEARCH database. / Kane, Christopher J.; Im, Ronald; Amling, Christopher L.; Presti, Joseph C.; Aronson, William J.; Terris, Martha K.; Freedland, Stephen J.

In: Urology, Vol. 76, No. 3, 01.09.2010, p. 695-700.

Research output: Contribution to journalArticle

Kane, Christopher J. ; Im, Ronald ; Amling, Christopher L. ; Presti, Joseph C. ; Aronson, William J. ; Terris, Martha K. ; Freedland, Stephen J. / Outcomes after radical prostatectomy among men who are candidates for active surveillance : Results from the SEARCH database. In: Urology. 2010 ; Vol. 76, No. 3. pp. 695-700.
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abstract = "Objective: We sought to evaluate outcomes after radical prostatectomy among men with low-risk prostate cancer who would be candidates for active surveillance. Methods: Using the Shared Equal Access Regional Cancer Hospital (SEARCH) database of men treated with radical prostatectomy at multiple equal-access medical centers between 1988 and 2007, 398 of 2062 men (19{\%}) met our criteria for potential active surveillance: clinical stage T1c or T2a, prostate-specific antigen (PSA) <10 ng/mL, Gleason sum ≤6, and no more than 1 or 2 positive cores on at least a sextant biopsy. We examined the risk of adverse pathology, biochemical progression, and PSA doubling time (PSADT) at the time of recurrence. We used a Cox proportional hazards model to determine the significant predictors of PSA progression. Results: Of the men with low-risk prostate cancer, 85{\%} had organ-confined disease, only 2{\%} had seminal vesicle invasion, and no patient had lymph node metastasis. The 5- and 10 year PSA-free survival rates were 81{\%} (95{\%} CI: 76-86{\%}) and 66{\%} (95{\%} CI: 54-76{\%}). On multivariate analysis, older age (P = .005), Agent Orange exposure (P = .02), and obesity (P = .03) were all significantly associated with biochemical failure. Mean and median PSADT among men who experienced recurrence were 37 and 20 months. Only 3 patients experienced recurrence with PSADT < 9 months. Conclusions: Most men with low-risk prostate cancer treated with radical prostatectomy experience long-term PSA control. Those who did experience recurrence often did so with a long PSADT. Consistent with prior SEARCH database reports, older age, Agent Orange exposure, and obesity increased the risk of recurrence.",
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AB - Objective: We sought to evaluate outcomes after radical prostatectomy among men with low-risk prostate cancer who would be candidates for active surveillance. Methods: Using the Shared Equal Access Regional Cancer Hospital (SEARCH) database of men treated with radical prostatectomy at multiple equal-access medical centers between 1988 and 2007, 398 of 2062 men (19%) met our criteria for potential active surveillance: clinical stage T1c or T2a, prostate-specific antigen (PSA) <10 ng/mL, Gleason sum ≤6, and no more than 1 or 2 positive cores on at least a sextant biopsy. We examined the risk of adverse pathology, biochemical progression, and PSA doubling time (PSADT) at the time of recurrence. We used a Cox proportional hazards model to determine the significant predictors of PSA progression. Results: Of the men with low-risk prostate cancer, 85% had organ-confined disease, only 2% had seminal vesicle invasion, and no patient had lymph node metastasis. The 5- and 10 year PSA-free survival rates were 81% (95% CI: 76-86%) and 66% (95% CI: 54-76%). On multivariate analysis, older age (P = .005), Agent Orange exposure (P = .02), and obesity (P = .03) were all significantly associated with biochemical failure. Mean and median PSADT among men who experienced recurrence were 37 and 20 months. Only 3 patients experienced recurrence with PSADT < 9 months. Conclusions: Most men with low-risk prostate cancer treated with radical prostatectomy experience long-term PSA control. Those who did experience recurrence often did so with a long PSADT. Consistent with prior SEARCH database reports, older age, Agent Orange exposure, and obesity increased the risk of recurrence.

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