TY - JOUR
T1 - Outcomes after radical prostatectomy among men who are candidates for active surveillance
T2 - Results from the SEARCH database
AU - Kane, Christopher J.
AU - Im, Ronald
AU - Amling, Christopher L.
AU - Presti, Joseph C.
AU - Aronson, William J.
AU - Terris, Martha K.
AU - Freedland, Stephen J.
N1 - Funding Information:
Supported by the Department of Veterans Affairs, National Institute of Health R01CA100938 (W.J.A.), National Institutes of Health Specialized Programs of Research Excellence Grant P50 CA92131-01A1 (W.J.A.), the Georgia Cancer Coalition (M.K.T.), the Department of Defense, Prostate Cancer Research Program , (S.J.F.), and the American Urological Association Foundation/Astellas Rising Star in Urology Award (S.J.F.). Views and opinions of, and endorsements by, the author(s) do not reflect those of the US Army or the Department of Defense.
PY - 2010/9
Y1 - 2010/9
N2 - 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.
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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U2 - 10.1016/j.urology.2009.12.073
DO - 10.1016/j.urology.2009.12.073
M3 - Article
C2 - 20394969
AN - SCOPUS:77954892457
SN - 0090-4295
VL - 76
SP - 695
EP - 700
JO - Urology
JF - Urology
IS - 3
ER -