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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
Author(s) -
Abern Michael R.,
Aronson William J.,
Terris Martha K.,
Kane Christopher J.,
Presti Joseph C.,
Amling Christopher L.,
Freedland Stephen J.
Publication year - 2013
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.22582
Subject(s) - biochemical recurrence , prostatectomy , medicine , prostate cancer , urology , hazard ratio , proportional hazards model , breakpoint cluster region , database , logistic regression , cancer , lower risk , prostate , biopsy , surgery , oncology , confidence interval , receptor , computer science
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.