1462 IS ACTIVE SURVEILLANCE ASSOCIATED WITH ADVERSE PATHOLOGIC OR SURGICAL OUTCOMES IN MEN EVENTUALLY CHOOSING DEFINITIVE TREATMENT WITH ROBOTIC RADICAL PROSTATECTOMY?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 20121462 IS ACTIVE SURVEILLANCE ASSOCIATED WITH ADVERSE PATHOLOGIC OR SURGICAL OUTCOMES IN MEN EVENTUALLY CHOOSING DEFINITIVE TREATMENT WITH ROBOTIC RADICAL PROSTATECTOMY? Rachael Sussman, Ilene Staff, Alison Champagne, Jamie Fish-Furhman, Joseph Tortora, Stuart Kesler, and Joseph Wagner Rachael SussmanRachael Sussman Farmington, CT More articles by this author , Ilene StaffIlene Staff Hartford, CT More articles by this author , Alison ChampagneAlison Champagne Hartford, CT More articles by this author , Jamie Fish-FurhmanJamie Fish-Furhman Hartford, CT More articles by this author , Joseph TortoraJoseph Tortora Hartford, CT More articles by this author , Stuart KeslerStuart Kesler Hartford, CT More articles by this author , and Joseph WagnerJoseph Wagner Hartford, CT More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1983AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many men with low risk prostate cancer choose active surveillance (AS) as opposed to definitive treatment such as initial robotic prostatectomy (RP) with the hope that opportunity for surgical cure will not be lost and in an effort to avoid the morbidity associated with definitive treatment. We evaluate whether a delay in definitive treatment with RP secondary to an initial treatment decision of AS was associated with adverse pathologic features, inability to perform nerve sparing surgery and biochemical recurrence. METHODS From our RP database we identified men with low risk prostate cancer (prostate-specific antigen (PSA) < 10 ng/mL, biopsy Gleason sum ≤ 6, cancer involvement of < 33% of biopsy cores, and clinical stage T1/T2a tumor) who were managed with initial AS, all of whom eventually underwent RP. Two control groups were selected: Control 1 was based on biopsy data at the time of diagnosis and Control 2 was based on biopsy data just prior to surgery. All unique patients fitting matching criteria (year of engagement +/1 year, PSA Partin Table Category (0-2.5, 2.6-4.0, etc), percent positive cores +/− 10%, clinical stage and Gleason score) were included. Ability to perform nerve sparing surgery, adverse pathologic features, and biochemical recurrence were compared between the study group and each control group. RESULTS See Table 1. Table 1. Study Group (n=41) Control Group 1 (n=164) p value % Gleason upgrading 81.1 46.3 .001 % pT3 24.4 12.8 n.s.(p.=.1) % bilateral nerve sparing 75.6 93.9 .001 % positive margins 31.7 19.5 n.s.(p.=.1) % biochemical recurrence 11.4 1.3 .012 Study Group (n=41) Control Group 2 (n=123) p value % Gleason upgrading 31.7 35.0 n.s. % pT3 24.4 20.2 n.s. % bilateral nerve sparing 75.6 84.2 n.s. % positive margins 31.7 27.6 n.s. % biochemical recurrence 11.4 5.7 n.s. CONCLUSIONS For men with low risk prostate cancer, treatment with AS followed by delayed RP impacted the incidence of bilateral nerve sparing surgery. There was an association between delayed RP and adverse pathologic features when comparing our cohort to a group of men with similar parameters at the time of diagnosis who chose treatment with initial RP. Since many men went on to surgery due toupgrading on surveillance biopsies, this was not unexpected. We hypothesized thatclose monitoring and multiple surveillance biopsies would correlate with improvedpathologic outcomes compared to patients who had undergone one set of biopsies and immediately underwent surgery, This was not the case as our cohort had the sameoutcomes when comparing them to men with similar parameters just prior to surgerywho were not an on AS protocol. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e592-e593 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachael Sussman Farmington, CT More articles by this author Ilene Staff Hartford, CT More articles by this author Alison Champagne Hartford, CT More articles by this author Jamie Fish-Furhman Hartford, CT More articles by this author Joseph Tortora Hartford, CT More articles by this author Stuart Kesler Hartford, CT More articles by this author Joseph Wagner Hartford, CT More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...