1340 PROTOCOL-BASED REASONS TO SWITCH TO RADICAL PROSTATECTOMY AFTER INITIAL ACTIVE SURVEILLANCE PREDICT FOR UNFAVOURABLE OUTCOME

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20121340 PROTOCOL-BASED REASONS TO SWITCH TO RADICAL PROSTATECTOMY AFTER INITIAL ACTIVE SURVEILLANCE PREDICT FOR UNFAVOURABLE OUTCOME Meelan Bul, Xiaoye Zhu, Chris Bangma, and Monique Roobol Meelan BulMeelan Bul Rotterdam, Netherlands More articles by this author , Xiaoye ZhuXiaoye Zhu Rotterdam, Netherlands More articles by this author , Chris BangmaChris Bangma Rotterdam, Netherlands More articles by this author , and Monique RoobolMonique Roobol Rotterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1722AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about the outcome of the radical prostatectomy (RP) specimens of men initially followed using active surveillance (AS) for low-risk prostate cancer (PC). We evaluated the association between the reason to switch to RP and RP outcome in our prospective AS cohort. METHODS Eligible men were initially diagnosed with low-risk PC (clinical stage =<T2, PSA =<10 ng/ml, PSA density <0.2 ng/ml/ml, 1 or 2 positive biopsy cores and Gleason score [GS] =<6) and underwent RP between December 2006 and July 2011. The study protocol recommends active treatment in case of risk reclassification on repeat biopsy after 1 yr (Gleason score >6 and/or >2 positive cores) or a PSA doubling-time =<3 yrs. Reasons to undergo active treatment in the form of RP and pathology findings on T stage and Gleason grade were studied. Unfavourable disease on RP was defined as T3-4 and/or GS >=4+3. RESULTS A total of 413 men switched to active therapy of which 189 men (46%) opted for RP. Pathology results were available in 167 men (88.4%). Median time to RP was 1.3 yrs (25-75p: 1.1-1.8 yrs). Protocol-based recommendations led to deferred RP in 128 (77%) men; 17 (10%) switched due to anxiety and 22 (13%) had other reasons (e.g. PSA increase). Pathology results showed T3 and T4 stage disease in 30 (18%) and 2 (1%) cases respectively. A GS of 4+3 was found in 21 cases (13%), while 3 (2%) had a GS of 8. The table shows the number of men with protocol-based reasons to switch to deferred treatment associated with either favourable or unfavourable RP results. In patients in whom anxiety triggered the choice for RP only 1 out of 17 (6%) had an unfavourable outcome. Number of men with protocol-based reasons to switch to deferred treatment with either favourable or unfavourable radical prostatectomy results N Favourable RP outcome (N = 118), (pT2 and GS =<3+4) Unfavourable RP outcome (N = 49), (pT3-4 and/or GS >=4+3) Protocol-based reason to switch to deferred treatment⁎ N (%) N (%) Any protocol-based reason 128 88(69) 40(31) 1.) GS >= 7 on repeat biopsy 23 18(78) 5(22) 2.) >= 3 positive cores on repeat biopsy 35 27(77) 8(23) 3.) PSA-DT =< 3yrs⁎⁎ 24 17(71) 7(29) Combination 1 + 2 21 10(48) 11(52) Combination 1 + 3 4 2(50) 2(50) Combination 2 + 3 17 12(71) 5(29) Combination 1 + 2 + 3 4 2(50) 2(50) N; number of patients, RP; radical prostatectomy, pT; pathological T stage, GS; Gleason score, ⁎ ; includes patients with the particular protocol-based reason in the absence of any other reason, PSA-DT; prostate-specific antigen doubling time, ⁎⁎ ; PSA-DT was used for recommendations only after a minimum of 4 follow-up visits CONCLUSIONS The majority of men in our cohort had a protocol-based reason to switch to deferred RP of whom a relatively high percentage had an unfavourable RP result when compared to men undergoing RP with no other reason than anxiety. Since risk reclassification during AS follow-up is common and often occurs within 1-2 yrs of diagnosis, it is important to improve selection of low-risk PC patients by adequate biopsy sampling at study entry and with regular repeat biopsies during follow-up, in order to prevent withholding curative treatment in patients at higher risk. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e543-e544 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Meelan Bul Rotterdam, Netherlands More articles by this author Xiaoye Zhu Rotterdam, Netherlands More articles by this author Chris Bangma Rotterdam, Netherlands More articles by this author Monique Roobol Rotterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...