MP46-08 SURGICAL OUTCOMES OF PATIENTS WHO FAIL ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER IN AN AUSTRALIAN POPULATION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2014MP46-08 SURGICAL OUTCOMES OF PATIENTS WHO FAIL ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER IN AN AUSTRALIAN POPULATION Arveen A. Kalapara, Adam J. Landau, Sam Farah, Jennifer Stone, Joseph Ischia, and Mark Frydenberg Arveen A. KalaparaArveen A. Kalapara More articles by this author , Adam J. LandauAdam J. Landau More articles by this author , Sam FarahSam Farah More articles by this author , Jennifer StoneJennifer Stone More articles by this author , Joseph IschiaJoseph Ischia More articles by this author , and Mark FrydenbergMark Frydenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1441AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Active surveillance (AS) is emerging as an alternative to immediate definitive therapy for localized prostate cancer. However, data on the outcomes of delayed radical prostatectomy (RP) after a period of AS is scarce. In this Australian-first study, our objective was to describe the surgical outcomes of patients who fail AS in an Australian population, including rates of unfavorable disease. Methods We retrospectively analyzed the records of men who underwent delayed RP after a period of initial AS at an Australian hospital between January 2001 and July 2013. Our AS inclusion criteria consisted of Gleason score (GS) ≤ 3+4=7, clinical stage ≤ T2 and less than 4 cores containing cancer. Confirmatory TRUS biopsy was performed at 1 year post-diagnosis, after which men underwent 3-yearly surveillance biopsies. Unfavorable disease on RP was defined as GS ≥ 4+3 or stage T3 disease, including extra-prostatic extension and seminal vesicle invasion. Statistical methods included descriptive analysis, simple frequencies and percentages. Results Of 280 men undergoing AS, 92 ceased surveillance and underwent delayed definitive treatment. This included 55 men who underwent RP after a mean surveillance period of 19.4 months. Mean age and PSA at diagnosis were 62.5 years and 7.15 ng/mL respectively. GS 6, GS 3+4 and GS ≥ 4+3 disease was found in 4 (7.3%), 33 (60.0%) and 18 (32.7%) of 55 men, respectively. 35 men (63.7%) had organ-confined disease, whilst stage T3a and T3b disease was found in 18 (32.7%) and 2 (3.6%) men, respectively. 1 man had positive local lymph nodes (1.8%) and no patients had metastatic disease. Overall, 28 of 55 men (50.9%) had unfavorable disease. However, only 7 men (12.7%) had both GS ≥ 4+3 and T3 disease. Furthermore, 7 of all 280 men (2.5%) experienced biochemical failure on post-surgical follow-up, all of whom were salvaged successfully using radiotherapy. Conclusions There are high rates of unfavorable disease among men who undergo delayed RP after AS. These tumors are higher grade and more extensive than would be expected in men on AS. However, the short surveillance period suggests misclassification of tumor on diagnostic biopsy rather than true tumor progression. More extensive template sampling and earlier confirmatory biopsy may assist in reducing rates of unfavorable disease. Nevertheless, our results support the overall safety of AS, with low rates of PSA failure and unsalvageable disease. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e512-e513 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Arveen A. Kalapara More articles by this author Adam J. Landau More articles by this author Sam Farah More articles by this author Jennifer Stone More articles by this author Joseph Ischia More articles by this author Mark Frydenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...