PD34-09 COMPARISON OF PATHOLOGIC OUTCOMES IN MEN WITH FAVORABLE-RISK PROSTATE CANCER UNDERGOING DELAYED SURGERY AFTER ACTIVE SURVEILLANCE VERSUS IMMEDIATE SURGERY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2015PD34-09 COMPARISON OF PATHOLOGIC OUTCOMES IN MEN WITH FAVORABLE-RISK PROSTATE CANCER UNDERGOING DELAYED SURGERY AFTER ACTIVE SURVEILLANCE VERSUS IMMEDIATE SURGERY Jeffrey Tosoian, Debasish Sundi, Bruce Trock, Patricia Landis, Jonathan Epstein, Edward Schaeffer, Mufaddal Mamawala, and H. Ballentine Carter Jeffrey TosoianJeffrey Tosoian More articles by this author , Debasish SundiDebasish Sundi More articles by this author , Bruce TrockBruce Trock More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2245AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term survival data comparing men in active surveillance (AS) to those undergoing surgery are limited. Prior studies of surgical outcomes that compare men undergoing delayed surgery in AS to those undergoing immediate surgery are biased by assessment of men in AS whose surgery was triggered by reclassification. Utilizing a unique population of men in AS that elected to undergo radical prostatectomy (RP) in the absence of reclassification, we compared pathological outcomes from a representative AS cohort to men who underwent immediate RP. METHODS Of 1,298 men on AS with favorable-risk (very low risk [VLR] or low risk [LR]) prostate cancer, 516 (39.8%) have been reclassified by grade and/or extent of cancer and 782 (60.2%) were not reclassified. We identified 57 men who initiated AS but subsequently elected RP in the absence of reclassification. These men provided unique pathologic data from an AS population typically excluded from outcome studies (i.e. patients without reclassification, 60% of AS cohort). Outcomes were combined with 38 men who were reclassified prior to surgery to compose a delayed RP (DRP) cohort representative of the overall AS population (i.e. 60% non-reclassified, 40% reclassified; including 6.5% by grade, 21.9% by volume, 11.6% by grade + volume). Pathology was compared with favorable-risk men who elected immediate RP (IRP) during the study period. The primary outcome was adverse pathology associated with increased prostate cancer-specific mortality, defined as primary Gleason pattern 4 or 5, seminal vesicle invasion, or positive lymph nodes. RESULTS There were no differences in the DRP sample and the overall AS cohort in terms of age, PSA density, and proportion of men with LR (28.4%) and VLR (71.6%) cancer (all p>0.05). Comparison of the DRP and IRP groups demonstrated a similar proportion of men with adverse pathology (23.1% vs. 21.3%, p=0.70). After adjustment for age, PSA density, number of positive biopsy cores, and percent core involvement, the odds ratio for adverse pathology in the DRP group after a median delay to surgery of 2.0 years (range 0.1-9.0) was 1.41 (95% CI 0.81-2.89, p=0.19) as compared to the IRP group. CONCLUSIONS Even considering the risk of reclassification during AS, carefully monitored men with favorable-risk prostate cancer are no more likely to demonstrate adverse features associated with prostate cancer death 15 years after surgery. These data suggest that long term outcomes with AS will be similar to outcomes of men undergoing immediate treatment. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e757-e758 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Tosoian More articles by this author Debasish Sundi More articles by this author Bruce Trock More articles by this author Patricia Landis More articles by this author Jonathan Epstein More articles by this author Edward Schaeffer More articles by this author Mufaddal Mamawala More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...