You have accessJournal of UrologyProstate Cancer: Localized (VII)1 Apr 20131497 OVERSTAGING HIGH-RISK PROSTATE CANCER MAY LEAD TO OVERTREATMENT: RESULTS FROM THE SEARCH DATABASE Michael Abern, William Aronson, Martha Terris, Christopher Kane, Christopher Amling, Matthew Cooperberg, and Stephen Freedland Michael AbernMichael Abern Durham, NC More articles by this author , William AronsonWilliam Aronson Los Angeles, CA More articles by this author , Martha TerrisMartha Terris Augusta, GA More articles by this author , Christopher KaneChristopher Kane San Diego, CA More articles by this author , Christopher AmlingChristopher Amling Portland, OR More articles by this author , Matthew CooperbergMatthew Cooperberg San Francisco, CA More articles by this author , and Stephen FreedlandStephen Freedland Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2976AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Androgen deprivation therapy (ADT) is recommended with radiotherapy for men with clinically high-risk prostate cancer (PC). However, high-risk men undergoing radical prostatectomy (RP) may be downgraded or downstaged, making ADT unnecessary. We sought to compare oncologic outcomes in clinically high-risk men that underwent RP who remained high-risk vs. those whose risk was downgraded due to favorable pathology. METHODS We retrospectively reviewed 665 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with RP without neoadjuvant therapy for clinically high-risk PC (PSA>20, biopsy Gleason≥8, or clinical stage ≥T3). Men were stratified into those remaining as high-risk (pre-op PSA>20, pathologic Gleason≥8, pathologic stage≥T3, or lymph node positive), or reclassified to lower risk based on RP pathology (no high-risk features). The outcomes tested were biochemical recurrence(BCR), receipt of ADT, metastases, and PC death. A multivariable model for receipt of ADT was adjusted for age, race, body mass index, and % biopsy cores positive. RESULTS Of the 665 high-risk men, 150(26%) were reclassified to lower risk based on RP pathology. At a median followup of 88 [51-139] months, only 16/150 (11%) of reclassified men ever received ADT, compared to 43% of those with high-risk features (p<0.001). No men that were reclassified as lower-risk received adjuvant ADT (within 3 months of RP), compared to 9% of men that remained high-risk. Reclassification to lower risk after RP was associated with decreased BCR (HR 0.30 [p<0.001]), receipt of ADT (HR 0.21 [p<0.001]), metastases (HR 0.20 [p=0.02]), and PC death (HR 0.10 [p=0.04]). After adjusting for multiple pre-operative features, reclassification remained significantly associated with decreased receipt of ADT. CONCLUSIONS In this cohort of high-risk men treated with RP, 68% have not received ADT at over 7 years of median followup. The 26% that were reclassified to lower risk based on pathology had excellent oncologic outcomes, with only 11% of these men receiving ADT. In comparison to radiotherapy wherein ADT is standard for high-risk men, treatment of clinically high-risk PC with RP provides oncological outcomes sufficient to avoid ADT use and its associated morbidity in over half the men at 7 years. Moreover, through accurate risk stratification, RP can identify a quarter of the men wherein ADT use is very uncommon. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e613-e614 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Abern Durham, NC More articles by this author William Aronson Los Angeles, CA More articles by this author Martha Terris Augusta, GA More articles by this author Christopher Kane San Diego, CA More articles by this author Christopher Amling Portland, OR More articles by this author Matthew Cooperberg San Francisco, CA More articles by this author Stephen Freedland Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...