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Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active Surveillance

Artikel i vetenskaplig tidskrift
Författare Rebecka Arnsrud Godtman
Max Schafferer
Carl Gustaf Pihl
Johan Stranne
Jonas Hugosson
Publicerad i Journal of Urology
Volym 200
Nummer/häfte 4
Sidor 779-785
ISSN 0022-5347
Publiceringsår 2018
Publicerad vid Institutionen för biomedicin, avdelningen för patologi
Institutionen för kliniska vetenskaper, Avdelningen för urologi
Sidor 779-785
Språk en
Länkar dx.doi.org/10.1016/j.juro.2018.04.0...
Ämnesord prostatic neoplasms, prostatectomy, watchful waiting, mass screening, disease progression, delayed prostatectomy, pathological outcomes, fusion biopsy, cancer, immediate, intermediate, management, cohort, Urology & Nephrology
Ämneskategorier Urologi och njurmedicin

Sammanfattning

Purpose: We sought to determine long-term outcomes after deferred radical prostatectomy. Materials and Methods: The study population consisted of all 132 men with screening detected prostate cancer who underwent deferred radical prostatectomy from January 1, 1995 to December 31, 2014 after active surveillance in the Goteborg Randomized, Population-based Prostate Cancer Screening Trial. The last date of followup was May 15, 2017. Followup during active surveillance was performed with prostate specific antigen tests every 3 to 6 months and repeat biopsies every 2 to 4 years. Triggers for radical prostatectomy were disease progression based on prostate specific antigen, grade and/or stage, or patient request. Outcomes included adverse pathology findings at radical prostatectomy, defined as Gleason score greater than 3 thorn 4, extraprostatic extension, positive margins, seminal vesicle invasion and/or Nthorn, whether the index tumor at radical prostatectomy was identified at biopsy and prostate specific antigen relapse-free survival. Kaplan-Meier analysis was performed. Results: Median time from diagnosis to surgery was 1.9 years (IQR 1.2-4.2) and median postoperative followup was 10.9 years (IQR 7.5-14.5). A total of 52 men (39%) experienced at least 1 unfavorable pathology feature at radical prostatectomy. The 10-year prostate specific antigen relapse-free survival was 79.5%. The index tumor was not identified in the diagnostic biopsy in 38 of the 132 men (29%) or at the last repeat biopsy that preceded radical prostatectomy 22 of 105 (21%). Conclusions: A large proportion of men had unfavorable pathology findings at deferred radical prostatectomy and the index tumor was frequently not identified. There is a clear need for better risk classification and protocols to determine disease progression during active surveillance.

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