Surgical management after active surveillance for low-risk prostate cancer: Pathological outcomes compared with men undergoing immediate treatment

Marc Dall'Era, Janet E. Cowan, Jeffrey Simko, Katsuto Shinohara, Benjamin Davies, Badrinath R. Konety, Maxwell V. Meng, Nannette Perez, Kirsten Greene, Peter R. Carroll

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

OBJECTIVE • To compare the pathological outcomes of men undergoing radical prostatectomy (RP) after a period of active surveillance (AS) with those of a similar risk group undergoing immediate surgery. PATIENTS AND METHODS • We identified men through our institutional database who underwent RP within 6 months of diagnosis or after a period of AS. The primary outcome of the present study was Gleason upgrade to ≥7 after prostatectomy. • Pathological stage and positive surgical margin rate were assessed as secondary outcomes. Binomial logistic regression models were used to determine associations of treatment subgroups with pathological upgrade, upstage and positive margins. RESULTS • Thirty-three men with initially low-risk cancer features underwent RP after a median (range) of 18 (7-76) months of AS. A total of 278 men with low-risk disease features underwent immediate RP within 6 months of diagnosis. Rates of Gleason upgrading to ≥7, pathological category pT3 and positive surgical margins did not differ significantly from the immediate RP group. • On multivariate analysis of low-risk patients, adjusting for baseline pathological features, treatment group (AS followed by prostatectomy vs immediate prostatectomy) was not associated with Gleason upgrading (odds ratio, OR, 0.35; 95% CI, 0.12-1.04), non-organ-confined disease (OR, 1.67; 95% CI, 0.32-8.65) or positive surgical margins at prostatectomy (OR, 0.95; 95% CI, 0.16-5.76). CONCLUSION • The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.

Original languageEnglish (US)
Pages (from-to)1232-1237
Number of pages6
JournalBJU International
Volume107
Issue number8
DOIs
StatePublished - Apr 2011

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Prostatectomy
Prostatic Neoplasms
Therapeutics
Logistic Models
Multivariate Analysis
Odds Ratio
Outcome Assessment (Health Care)
Databases

Keywords

  • active surveillance
  • prostate cancer
  • radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Surgical management after active surveillance for low-risk prostate cancer : Pathological outcomes compared with men undergoing immediate treatment. / Dall'Era, Marc; Cowan, Janet E.; Simko, Jeffrey; Shinohara, Katsuto; Davies, Benjamin; Konety, Badrinath R.; Meng, Maxwell V.; Perez, Nannette; Greene, Kirsten; Carroll, Peter R.

In: BJU International, Vol. 107, No. 8, 04.2011, p. 1232-1237.

Research output: Contribution to journalArticle

Dall'Era, M, Cowan, JE, Simko, J, Shinohara, K, Davies, B, Konety, BR, Meng, MV, Perez, N, Greene, K & Carroll, PR 2011, 'Surgical management after active surveillance for low-risk prostate cancer: Pathological outcomes compared with men undergoing immediate treatment', BJU International, vol. 107, no. 8, pp. 1232-1237. https://doi.org/10.1111/j.1464-410X.2010.09589.x
Dall'Era, Marc ; Cowan, Janet E. ; Simko, Jeffrey ; Shinohara, Katsuto ; Davies, Benjamin ; Konety, Badrinath R. ; Meng, Maxwell V. ; Perez, Nannette ; Greene, Kirsten ; Carroll, Peter R. / Surgical management after active surveillance for low-risk prostate cancer : Pathological outcomes compared with men undergoing immediate treatment. In: BJU International. 2011 ; Vol. 107, No. 8. pp. 1232-1237.
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T2 - Pathological outcomes compared with men undergoing immediate treatment

AU - Dall'Era, Marc

AU - Cowan, Janet E.

AU - Simko, Jeffrey

AU - Shinohara, Katsuto

AU - Davies, Benjamin

AU - Konety, Badrinath R.

AU - Meng, Maxwell V.

AU - Perez, Nannette

AU - Greene, Kirsten

AU - Carroll, Peter R.

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N2 - OBJECTIVE • To compare the pathological outcomes of men undergoing radical prostatectomy (RP) after a period of active surveillance (AS) with those of a similar risk group undergoing immediate surgery. PATIENTS AND METHODS • We identified men through our institutional database who underwent RP within 6 months of diagnosis or after a period of AS. The primary outcome of the present study was Gleason upgrade to ≥7 after prostatectomy. • Pathological stage and positive surgical margin rate were assessed as secondary outcomes. Binomial logistic regression models were used to determine associations of treatment subgroups with pathological upgrade, upstage and positive margins. RESULTS • Thirty-three men with initially low-risk cancer features underwent RP after a median (range) of 18 (7-76) months of AS. A total of 278 men with low-risk disease features underwent immediate RP within 6 months of diagnosis. Rates of Gleason upgrading to ≥7, pathological category pT3 and positive surgical margins did not differ significantly from the immediate RP group. • On multivariate analysis of low-risk patients, adjusting for baseline pathological features, treatment group (AS followed by prostatectomy vs immediate prostatectomy) was not associated with Gleason upgrading (odds ratio, OR, 0.35; 95% CI, 0.12-1.04), non-organ-confined disease (OR, 1.67; 95% CI, 0.32-8.65) or positive surgical margins at prostatectomy (OR, 0.95; 95% CI, 0.16-5.76). CONCLUSION • The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.

AB - OBJECTIVE • To compare the pathological outcomes of men undergoing radical prostatectomy (RP) after a period of active surveillance (AS) with those of a similar risk group undergoing immediate surgery. PATIENTS AND METHODS • We identified men through our institutional database who underwent RP within 6 months of diagnosis or after a period of AS. The primary outcome of the present study was Gleason upgrade to ≥7 after prostatectomy. • Pathological stage and positive surgical margin rate were assessed as secondary outcomes. Binomial logistic regression models were used to determine associations of treatment subgroups with pathological upgrade, upstage and positive margins. RESULTS • Thirty-three men with initially low-risk cancer features underwent RP after a median (range) of 18 (7-76) months of AS. A total of 278 men with low-risk disease features underwent immediate RP within 6 months of diagnosis. Rates of Gleason upgrading to ≥7, pathological category pT3 and positive surgical margins did not differ significantly from the immediate RP group. • On multivariate analysis of low-risk patients, adjusting for baseline pathological features, treatment group (AS followed by prostatectomy vs immediate prostatectomy) was not associated with Gleason upgrading (odds ratio, OR, 0.35; 95% CI, 0.12-1.04), non-organ-confined disease (OR, 1.67; 95% CI, 0.32-8.65) or positive surgical margins at prostatectomy (OR, 0.95; 95% CI, 0.16-5.76). CONCLUSION • The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.

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