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Scand J Urol. 2016 Aug;50(4):246-54. doi: 10.3109/21681805.2016.1166153. Epub 2016 Apr 12.

Immediate versus delayed prostatectomy: Nationwide population-based study (.).

Author information

1
a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA ;
2
b Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital , Uppsala , Sweden ;
3
c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden ;
4
d Department of Urology , Ryhov County Hospital , Jönköping , Sweden ;
5
e Department of Urology, CamPARI Clinic , Addenbrooke's Hospital , Cambridge , UK ;
6
f Department of Translational Sciences , Lund University , Lund , Sweden ;
7
g Faculty of Life Sciences and Medicine, Division of Cancer Studies , King's College London , London , UK ;
8
h Department of Surgical Sciences , Uppsala University , Uppsala , Sweden.

Abstract

OBJECTIVE:

The aim of this study was to compare the outcome of immediate versus delayed radical prostatectomy (RP) in men with low-grade prostate cancer.

MATERIALS AND METHODS:

The study included a nationwide population-based cohort in the National Prostate Cancer Register of Sweden, of 7608 men with clinically localized, biopsy Gleason score 6 prostate cancer who underwent immediate or delayed RP in 1997-2007. Multivariable models compared RP pathology, use of salvage radiotherapy and prostate cancer mortality based on timing of RP (< 1, 1-2 or >2 years after diagnosis). Median follow-up was 8.1 years.

RESULTS:

Men undergoing RP more than 2 years after diagnosis had a higher risk of Gleason upgrading [odds ratio 2.93, 95% confidence interval (CI) 2.34-3.68] and an increased risk of salvage radiotherapy [hazard ratio (HR) 1.90, 95% CI 1.41-2.55], but no significant increase in prostate cancer-specific mortality (HR 1.85, 95% CI 0.57-5.99). In competing risk analysis, 7 year prostate cancer-specific cumulative mortality was similar, at less than 1%, for immediate RP and active surveillance regardless of later intervention. Limitations of this study include the lack of data on follow-up biopsies and the limited follow-up time.

CONCLUSION:

Men undergoing RP more than 2 years after diagnosis had more adverse pathological features and second line therapy, highlighting the trade-off in deferring immediate curative therapy. However, men with delayed RP constitute a minority with higher risk cancer among the much larger group of low-risk men initially surveilled, and the overall risk of prostate cancer mortality at 7 years was similarly low with immediate RP or active surveillance.

KEYWORDS:

Active surveillance; outcomes; prognosis; prostate cancer; radical prostatectomy; surgical delay

PMID:
27067998
PMCID:
PMC4979613
DOI:
10.3109/21681805.2016.1166153
[Indexed for MEDLINE]
Free PMC Article

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