PD34-10 OUTCOMES FOLLOWING IMMEDIATE VERSUS DELAYED RADICAL PROSTATECTOMY AMONG PATIENTS ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2015PD34-10 OUTCOMES FOLLOWING IMMEDIATE VERSUS DELAYED RADICAL PROSTATECTOMY AMONG PATIENTS ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER Pauline Filippou, Christopher Welty, Janet Cowan, and Peter Carroll Pauline FilippouPauline Filippou More articles by this author , Christopher WeltyChristopher Welty More articles by this author , Janet CowanJanet Cowan More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2246AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about the risk of delaying radical prostatectomy (RP) until biopsy progression following active surveillance (AS) for prostate cancer. This study examines the pathological outcomes associated with surgery following AS compared to immediate treatment of prostate cancer with similar grades. METHODS Men who underwent RP between 1997-2013 at University of California San Francisco were included. The first comparison consisted of men who met strict AS inclusion criteria (Gleason Score ≤6, PSA ≤10, clinical stage <T3, ≤33% biopsy cores positive, and ≤50% of any single core positive) at diagnosis) and underwent AS prior to RP (AS+RP) compared to men who met strict AS criteria and underwent RP within 6 months (immediate RP). The second comparison consisted of men who met strict AS criteria and were upgraded on follow-up biopsy compared to a cohort of men matched on the basis pre-treatment biopsy pathology. Logistic regression was used to determine associations of RP group with adverse pathology (stage ≥pT3/N1, positive margins, and/or upgrade to Gleason ≥4+3), adjusting for clinical and demographic factors. RESULTS We identified 241 men who underwent RP after a period of AS, 157 of whom initially met strict AS criteria. The median time to RP was 20 months (IQR 14-36). Men who met strict criteria and underwent immediate RP were less likely to have adverse pathology than those who underwent AS+RP (OR 0.39, 95% CI 0.24-0.62). 54 of the men who underwent AS+RP did so have upgrading to Gleason 3+4 disease on surveillance biopsy. These patients were matched with 154 men based on their pre-treatment biopsy features. After appropriate matching, the timing of RP was not associated with adverse pathology (OR 1.27, 9% CI 0.65-2.49). CONCLUSIONS Men who undergo surgery following AS are a selected subset of men with low risk prostate cancer. The surgical pathology features of these patients are more similar to men undergo surgery after diagnosis with intermediate risk prostate cancer than those diagnosed with very low risk disease. Additional follow-up of this and other cohorts is needed to assess long term clinical outcomes following delayed RP. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e758 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pauline Filippou More articles by this author Christopher Welty More articles by this author Janet Cowan More articles by this author Peter Carroll More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...