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Semba R, Uchida K, Hirokawa Y, Shiraishi T, Onishi T, Sasaki T, Inoue T, Watanabe M. Short-term prognosis of low-risk prostate cancer patients is favorable despite the presence of pathological prognostic factors: a retrospective study. BMC Urol 2023; 23:174. [PMID: 37904171 PMCID: PMC10617070 DOI: 10.1186/s12894-023-01345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Prostate cancer patients with pathological prognostic factors have a poor prognosis, but it is unclear whether pathological prognostic factors are associated with prognosis limited to low-risk patients with good prognosis according to NCCN guidelines. The present study examined whether prognosis is influenced by pathological prognostic factors using radical prostatectomy (RP) specimens from low-risk patients. METHODS We evaluated diagnostic accuracy by examining biochemical recurrence (BCR)-free survival with respect to clinical and pathological prognostic factors in 419 all-risk patients who underwent RP. Clinical prognostic factors included age, prostate-specific antigen (PSA) levels, PSA density, and risk stratification, while pathological prognostic factors included grade group, lymphovascular space invasion, extraprostatic extension, surgical margins, seminal vesicle invasion, intraductal carcinoma of the prostate (IDCP), and pT. In a subsequent analysis restricted to 104 low-risk patients, survival curves were estimated for pathological prognostic factors using the Kaplan-Meier method and compared using log-rank and generalized Wilcoxon tests. RESULTS In the overall risk analysis, the presence of pathological prognostic factors significantly shortened BCR-free survival (p < 0.05). Univariable analysis revealed that PSA density, risk categories, and pathological prognostic factors were significantly associated with BCR-free survival, although age and PSA were not. In multivariable analysis, age, risk categories, grade group, IDCP, and pT significantly predicted BCR-free survival (p < 0.05). Conversely, no statistically significant differences were found for any pathological prognostic factors in low-risk patients. CONCLUSIONS In low-risk patients, pathological prognostic factors did not affect BCR-free survival, which suggests that additional treatment may be unnecessary even if pathological prognostic factors are observed in low-risk patients with RP.
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Affiliation(s)
- Remi Semba
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pathology, Kuwana City Medical Center, Kuwana, Mie, Japan
| | - Katsunori Uchida
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yoshihumi Hirokawa
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Taizo Shiraishi
- Department of Pathology, Kuwana City Medical Center, Kuwana, Mie, Japan
| | - Takehisa Onishi
- Department of Urology, Japanese Red Cross Ise Hospital, Ise, Mie, Japan
| | - Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Hospital, Tsu, Mie, Japan
| | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Hospital, Tsu, Mie, Japan
| | - Masatoshi Watanabe
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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3
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Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13133274. [PMID: 34208888 PMCID: PMC8268689 DOI: 10.3390/cancers13133274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary We reviewed the evidence available for postponing or delaying cancer surgery for localised prostate cancer. Watchful waiting is an acceptable option in low-risk patients. Evidence is uncertain in postponing surgery, but conservative estimates suggest delays of over 5 months, 4 months, and 30 days for low-, intermediate-, and high-risk patients, respectively, can lead to worse survival outcomes. Neoadjuvant therapy can shrink the tumours prior to surgery and can be a useful adjunct in delaying surgery for, at the most, 3 months. Abstract External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle–Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.
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Avci S, Caglayan V. How can we predict the active surveillance candidates meeting all Epstein criteria prior to prostate biopsy to avoid overdiagnosis? Aging Male 2020; 23:1289-1295. [PMID: 32406325 DOI: 10.1080/13685538.2020.1764524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of PSA, prostate volume (PV) and free-to-total PSA ratio (fPSA%) in predicting patients meeting all active surveillance criteria, including Epstein criteria. METHOD Retrospective analysis was made of the data of 1901 men who underwent transrectal ultrasound (TRUS)-guided prostate biopsy in our clinic between January 2015 and December 2019. The active surveillance criteria were determined as Gleason score ≤6, when specified ≤2 positive cores with <50% cancer involvement in every positive core, a clinical T1c, a PSA <10ng/mL and a PSA density <0.15 ng/mL/cc. Patients who met all active surveillance criteria were included in Group 1, and other patients with prostate cancer were included in Group 2. RESULTS The study included 336 patients with available data of age, total-free PSA levels, PV calculated by TRUS. Group 1 consisted of 82 patients and Group 2 consisted of 254 patients. PV and fPSA% were significantly higher and PSA was significantly lower in Group 1 than in Group 2. On multivariate analysis, the independent predictors were determined to be PSA and PV while fPSA% was not. CONCLUSION By using PSA and PV in predicting patients meeting all active surveillance criteria, unnecessary biopsies and ultimately overdiagnosis can be reduced.
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Affiliation(s)
- Sinan Avci
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Volkan Caglayan
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Impact of surgical wait times during summer months on the oncological outcomes following robotic-assisted radical prostatectomy: 10 years' experience from a large Canadian academic center. World J Urol 2020; 39:2913-2919. [PMID: 33106941 DOI: 10.1007/s00345-020-03496-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Most Canadian hospitals face significant reductions in operating room access during the summer. We sought to assess the impact of longer wait times on the oncological outcomes of localized prostate cancer patients following robotic-assisted radical prostatectomy (RARP). METHODS We conducted a retrospective review of a prospectively maintained RARP database in two high-volume academic centers, between 2010 and 2019. Assessed outcomes included the difference between post-biopsy UCSF-CAPRA and post-surgical CAPRA-S scores, Gleason score upgrade and biochemical recurrence rates (BCR). Multivariable regression analyses (MVA) were used to evaluate the effect of wait times. RESULTS A total of 1057 men were included for analysis. Consistent over a 10 year period, summer months had the lowest surgical volumes despite above average booking volumes. The lowest surgical volume occurred during the month of July (7.1 cases on average), which was 35% less than the cohort average. The longest average wait times occurred for patients booked in June (93 ± 69 days, p < 0.001). On MVA, patients booked in June had significantly more chance of having an increase in CAPRA score [HR (95% CI) 1.64 (1.02-2.63); p = 0.04] and in CAPRA risk group [HR (95% CI) 1.82 (1.04-3.19); p = 0.03]. Cohort analysis showed fair correlation between CAPRA-score difference and wait time (Pearson correlation: r = - 0.062; p = 0.044). CONCLUSION Our cohort results demonstrate that conventional RARP wait times are significantly and consistently prolonged during summer months over the past 10 years, with worse post-RARP oncological outcomes in terms of CAPRA scores. Other compensatory mechanisms to sustain consistent yearly operative output should be considered.
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Savin Z, Dekalo S, Marom R, Barnes S, Gitstein G, Mabjeesh NJ, Matzkin H, Yossepowitch O, Keren-Paz G, Mano R. The effect of delaying transperineal fusion biopsy of the prostate for patients with suspicious MRI findings-Implications for the COVID-19 era. Urol Oncol 2020; 39:73.e1-73.e8. [PMID: 32778478 PMCID: PMC7413128 DOI: 10.1016/j.urolonc.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/10/2020] [Accepted: 07/08/2020] [Indexed: 12/02/2022]
Abstract
Objective Image guided biopsies are an integral part of prostate cancer evaluation. The effect of delaying biopsies of suspicious prostate mpMRI lesions is uncertain and clinically relevant during the COVID-19 crisis. We evaluated the association between biopsy delay time and pathologic findings on subsequent prostate biopsy. Materials and methods After obtaining IRB approval we reviewed the medical records of 214 patients who underwent image-guided transperineal fusion biopsy of the prostate biopsy between 2017 and 2019. Study outcomes included clinically significant (ISUP grade group ≥2) and any prostate cancer on biopsy. Logistic regression was used to evaluate the association between biopsy delay time and outcomes while adjusting for known predictors of cancer on biopsy. Results The study cohort included 195 men with a median age of 68. Median delay between mpMRI and biopsy was 5 months, and 90% of patients had a ≤8 months delay. A significant association was found between PI-RADS 5 lesions and no previous biopsies and shorter delay time. Delay time was not associated with clinically significant or any cancer on biopsy. A higher risk of significant cancer was associated with older age (P = 0.008), higher PSA (0.003), smaller prostate volume (<0.001), no previous biopsy (0.012) and PI-RADS 5 lesions (0.015). Conclusions Our findings suggest that under current practice, where men with PI-RADS 5 lesions and no previous biopsies undergo earlier evaluation, a delay of up to 8 months between imaging and biopsy does not affect biopsy findings. In the current COVID-19 crisis, selectively delaying image-guided prostate biopsies is unlikely to result in a higher rate of significant cancer.
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Affiliation(s)
- Ziv Savin
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Snir Dekalo
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ron Marom
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Sophie Barnes
- Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Gilad Gitstein
- Department of Pathology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Nicola J Mabjeesh
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Department of Urology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Haim Matzkin
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Gal Keren-Paz
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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Mamawala MK, Meyer AR, Landis PK, Macura KJ, Epstein JI, Partin AW, Carter BH, Gorin MA. Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance. BJU Int 2020; 125:861-866. [PMID: 32039537 DOI: 10.1111/bju.15033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess if the adoption of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) has improved the identification of occult higher-grade prostate cancer (PCa). PATIENTS AND METHODS We retrospectively identified men from the Johns Hopkins AS registry enrolled since 2013 (year of mpMRI adoption) with Grade Group (GG) 1 PCa and who underwent a single mpMRI. Men in this group were dichotomised by the presence (n = 207) or absence (negative mpMRI, n = 225) of one or more lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥ 3. Both groups were compared to a third cohort of men with GG1 PCa enrolled in AS prior to 2013 (pre-mpMRI era, n = 669). The risk of upgrading to GG ≥ 2 PCa on follow-up biopsies (performed with or without MRI targeting) was evaluated among the groups using survival analysis. RESULTS Men in both mpMRI groups underwent a median (interquartile range [IQR]) of 2 (2-3) biopsies separated by a median (IQR) interval of 13 (12-16) months, whereas men in the pre-MRI era underwent a median (IQR) of 3 (2-5) biopsies, separated by a median (IQR) interval of 12 (12-14) months. The 2- and 4-year upgrade-free survival rates were 93% and 83%, 74% and 59%; and, 87% and 76% for the negative mpMRI, PI-RADS ≥ 3, and pre-mpMRI-era groups, respectively (P < 0.001). On multivariable analysis, both mpMRI groups had significantly different risk of upgrading compared to pre-mpMRI-era group (negative mpMRI group: hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39-0.95, P = 0.03; PI-RADS ≥ 3 group: HR 1.96, 95% CI 1.36-2.82, P < 0.001). CONCLUSIONS mpMRI improves the risk stratification of men on AS and should be used to aid enrolment and monitoring decisions.
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Affiliation(s)
- Mufaddal K Mamawala
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alexa R Meyer
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Patricia K Landis
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Katarzyna J Macura
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jonathan I Epstein
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alan W Partin
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ballentine H Carter
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Kim SJ, Ryu JH, Yang SO, Lee JK, Jung TY, Kim YB. Does the Time Interval from Biopsy to Radical Prostatectomy Affect the Postoperative Oncologic Outcomes in Korean Men? J Korean Med Sci 2019; 34:e234. [PMID: 31559708 PMCID: PMC6763398 DOI: 10.3346/jkms.2019.34.e234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prostate cancer (PC) is the second most common type of cancer in men worldwide and the fifth most common cancer among Korean men. Although most PCs grow slowly, it is unclear whether a longer time interval from diagnosis to treatment causes worse outcomes. This study aimed to investigate whether the time interval from diagnosis to radical prostatectomy (RP) in men with clinically localized PC affects postoperative oncologic outcomes. METHODS We retrospectively analyzed data of 427 men who underwent RP for localized PC between January 2005 and June 2016. The patients were divided into two groups based on the cutoff median time interval (100 days) from biopsy to surgery. The associations between time interval from biopsy to surgery (< 100 vs. ≥ 100 days) and adverse pathologic outcomes such as positive surgical margin, pathologic upgrading, and upstaging were evaluated. Biochemical recurrence (BCR)-free survival rates were analyzed and compared based on the time interval from biopsy to surgery. RESULTS Pathologic upgrading of Gleason score in surgical specimens was more frequent in the longer time interval group and showed marginal significance (38.8% vs. 30.0%; P = 0.057). Based on multivariable analysis, an association was observed between time interval from biopsy to surgery and pathologic upgrading (odds ratio, 2.211; 95% confidence interval [CI], 1.342-3.645; P = 0.002). BCR-free survival did not differ based on time interval from biopsy to surgery, and significant association was not observed between time interval from biopsy to surgery and BCR on multivariable analysis (hazard ratio, 1.285; 95% CI, 0.795-2.077; P = 0.305). CONCLUSION Time interval ≥ 100 days from biopsy to RP in clinically localized PC increased the risk of pathologic upgrading but did not affect long-term BCR-free survival rates in Korean men.
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Affiliation(s)
- Sang Jin Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Ok Yang
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Jeong Kee Lee
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea.
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Dai C, Ganesan V, Nyame YA, Almassi N, Greene DJ, Hettel D, Magi-Galluzzi C, Gong M, Jones JS, Stephenson AJ, Berglund RK, Klein EA. Older Age at Diagnosis and Initial Disease Volume Predict Grade Reclassification Risk on Confirmatory Biopsy in Patients Considered for Active Surveillance. Urology 2019; 130:106-112. [PMID: 31071349 DOI: 10.1016/j.urology.2019.02.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify which active surveillance candidates benefit most from confirmatory biopsies to exclude grade underclassification. MATERIALS AND METHODS This observational study includes 556 men diagnosed between 2002 and 2015 with Gleason 3 + 3 (GG1) disease on initial diagnostic biopsy, of whom 406 received a confirmatory biopsy within 12 months for active surveillance. Multivariable logistic regression analysis was performed to determine clinicopathologic features associated with Gleason 7 or higher (GG2+) on a confirmatory biopsy. Regression tree analysis was employed to stratify patients into select risk groups. RESULTS Eighty-five of 406 patients (20.9%) with initially GG1 disease were reclassified to GG2+ on a confirmatory biopsy. On multivariable analysis, increasing age (per year odds ratio 1.07; 95% confidence interval 1.02-1.12; P <.01) and more positive cores at diagnosis (per core, odds ratio 1.37, 95% confidence interval 1.09-1.72; P <.01) were significantly associated with reclassification, independent of prostate volume, clinical stage, initial PSA, or confirmatory biopsy type (including magnetic resonance imaging-targeted approaches or transrectal saturation random sampling). Recursive partitioning demonstrated that age over 73 and 5 or more positive cores were factors associated with the greatest reclassification risk. CONCLUSION In our cohort, both advancing age and additional positive cores were associated with increased odds of reclassification to GG2+ on confirmatory biopsy. In men over age 73 or with 5 or more positive cores, a repeat biopsy within 12 months may be particularly beneficial to minimize tumor grade underclassification.
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Affiliation(s)
- Charles Dai
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Vishnu Ganesan
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, UT Southwestern Medical Center, Dallas, TX
| | - Yaw A Nyame
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel J Greene
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Hettel
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Michael Gong
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Andrew J Stephenson
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan K Berglund
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Klein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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11
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Awasthi S, Gerke T, Park JY, Asamoah FA, Williams VL, Fink AK, Balkrishnan R, Lee DI, Malkowicz SB, Lal P, Dhillon J, Pow-Sang JM, Rebbeck TR, Yamoah K. Optimizing Time to Treatment to Achieve Durable Biochemical Disease Control after Surgery in Prostate Cancer: A Multi-Institutional Cohort Study. Cancer Epidemiol Biomarkers Prev 2018; 28:570-577. [PMID: 30413401 DOI: 10.1158/1055-9965.epi-18-0812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/09/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The impact of treatment delays on prostate cancer-specific outcomes remains ill-defined. This study investigates the effect of time to treatment on biochemical disease control after prostatectomy. METHODS This retrospective study includes 1,807 patients who received a prostatectomy as a primary treatment at two large tertiary referral centers from 1987 to 2015. Multivariate cox model with restricted cubic spline was used to identify optimal time to receive treatment and estimate the risk of biochemical recurrence. RESULTS Median follow-up time of the study was 46 (interquartile range, 18-86) months. Time to treatment was subcategorized based on multivariate cubic spline cox model. In multivariate spline model, adjusted for all the pertinent pretreatment variables, inflection point in the risk of biochemical recurrence was observed around 3 months, which further increased after 6 months. Based on spline model, time to treatment was then divided into 0 to 3 months (61.5%), >3 to 6 months (31.1%), and 6 months (7.4%). In the adjusted cox model, initial delays up to 6 months did not adversely affect the outcome; however, time to treatment >6 months had significantly higher risk of biochemical recurrence (HR, 1.84; 95% confidence interval, 1.30-2.60; P < 0.01). CONCLUSIONS The initial delays up to 6 months in prostate cancer primary treatment may be sustainable without adversely affecting the outcome. However, significant delays beyond 6 months can unfavorably affect biochemical disease control. IMPACT Time to treatment can aid clinicians in the decision-making of prostate cancer treatment recommendation and educate patients against unintentional treatment delays.
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Affiliation(s)
- Shivanshu Awasthi
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Travis Gerke
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Collaborative Data Services Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jong Y Park
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Francis A Asamoah
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vonetta L Williams
- Collaborative Data Services Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Angelina K Fink
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - David I Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Bruce Malkowicz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Priti Lal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jasreman Dhillon
- Department of Pathologic Anatomic, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julio M Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Timothy R Rebbeck
- Cancer Epidemiology and Cancer Risk and Disparity, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kosj Yamoah
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. .,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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12
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Rozet F, Hennequin C, Beauval JB, Beuzeboc P, Cormier L, Fromont-Hankard G, Mongiat-Artus P, Ploussard G, Mathieu R, Brureau L, Ouzzane A, Azria D, Brenot-Rossi I, Cancel-Tassin G, Cussenot O, Rebillard X, Lebret T, Soulié M, Penna RR, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : cancer de la prostate French ccAFU guidelines – Update 2018–2020: Prostate cancer. Prog Urol 2018; 28:S79-S130. [PMID: 30392712 DOI: 10.1016/j.purol.2018.08.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.007.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.007.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- F Rozet
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, institut mutualiste Montsouris, université René-Descartes, 42, boulevard Jourdan, 75674, Paris, France.
| | - C Hennequin
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de radiothérapie, Saint-Louis Hospital, AP-HP, 75010, Paris, France
| | - J-B Beauval
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, oncologie médicale, institut universitaire du cancer Toulouse-Oncopole, CHU Rangueil, 31100, Toulouse, France
| | - P Beuzeboc
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Foch, 92150, Suresnes, France
| | - L Cormier
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU François-Mitterrand, 21000, Dijon, France
| | - G Fromont-Hankard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; CHU de Tours, 2, boulevard Tonnellé, 37000, Tours, France
| | - P Mongiat-Artus
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, Paris cedex 10, France
| | - G Ploussard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, clinique La Croix du Sud-Saint-Jean Languedoc, institut universitaire du cancer, 31100, Toulouse, France
| | - R Mathieu
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital de Rennes, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - L Brureau
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Inserm, U1085, IRSET, 97145 Pointe-à-Pitre, Guadeloupe
| | - A Ouzzane
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000, Lille, France
| | - D Azria
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Inserm U1194, ICM, université de Montpellier, 34298, Montpellier, France
| | - I Brenot-Rossi
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - G Cancel-Tassin
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; GRC no 5 ONCOTYPE-URO, institut universitaire de cancérologie, Sorbonne université, 75020, Paris, France
| | - O Cussenot
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Tenon, AP-HP, Sorbonne université, 75020, Paris, France
| | - X Rebillard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, clinique mutualiste Beau-Soleil, 119, avenue de Lodève, 34070, Montpellier, France
| | - T Lebret
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Foch, 92150, Suresnes, France
| | - M Soulié
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre hospitalier universitaire Rangueil, 31059, Toulouse, France
| | - R Renard Penna
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; GRC no 5 ONCOTYPE-URO, institut universitaire de cancérologie, Sorbonne université, 75020, Paris, France; Service de radiologie, hôpital Tenon, AP-HP, 75020, Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique des hôpitaux de Paris (AP-HP), 75015, Paris, France
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Rozet F, Hennequin C, Beauval JB, Beuzeboc P, Cormier L, Fromont-Hankard G, Mongiat-Artus P, Ploussard G, Mathieu R, Brureau L, Ouzzane A, Azria D, Brenot-Rossi I, Cancel-Tassin G, Cussenot O, Rebillard X, Lebret T, Soulié M, Renard Penna R, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : cancer de la prostate. Prog Urol 2018; 28 Suppl 1:R81-R132. [DOI: 10.1016/j.purol.2019.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/02/2023]
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14
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Morini MA, Muller RL, de Castro Junior PCB, de Souza RJ, Faria EF. Time between diagnosis and surgical treatment on pathological and clinical outcomes in prostate cancer: does it matter? World J Urol 2018; 36:1225-1231. [PMID: 29549484 DOI: 10.1007/s00345-018-2251-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/23/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Prostate cancer (PC) most of the time presents with an indolent course. Thus, delays in treatment due to any causes might not affect long-term survival and may not affect cancer cure rates. PURPOSE In this study, we evaluated the effect of delay-time between PC diagnosis and radical prostatectomy regarding oncological outcomes: Gleason score upgrade on surgical specimen, pathologic extracapsular extension (ECE) on surgical specimen, and postoperative biochemical recurrence (BCR) on follow-up. METHODS We evaluated PC patients who underwent radical prostatectomy (RP) regarding clinical and pathological findings and theirs respective interval between diagnosis and surgical treatment measured in days and months. We used univariate and multivariate logistic regression to evaluate the impact of interval-time. RESULTS A total of 908 PC patients underwent RP between 2006 and 2014. Mean age was 61.5 years, the mean time-to-surgery was 191 days (> 6 months) and 187 (20.5%) patients had BCR, with a mean follow-up of 44 months. According to our analysis, no statistically significant maximum cut-off time interval between diagnostic biopsy and surgery could be established (p = 0.215). Regardless of interval-time: ≤ 6 months (56.5%), 6-12 months (38.5%), and > 12 months (5.1%) after biopsy, we found no time interval correlated with poor oncological outcomes. This study has several limitations. It was retrospective and had a mean follow-up of 4 years. Additional follow-up is necessary to determine whether these findings will be maintained over time. CONCLUSIONS We showed that the time between diagnosis and surgical treatment did not affect the oncological outcomes in our study.
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Affiliation(s)
| | | | | | - Rafael José de Souza
- Barretos Cancer Hospital, Alameda Nicaragua 252, Bairro City, Barretos, SP, Brazil
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15
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Berlin A, Ahmad AE, Chua MLK, Moraes FY, Jiang H, Komisarenko M, Trimilshina N, Raziee H, Hosni A, Murgic J, Chung P, Bristow RG, Finelli A. Curative Radiation Therapy at Time of Progression Under Active Surveillance Compared With Up-front Radical Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 100:702-709. [PMID: 29249526 DOI: 10.1016/j.ijrobp.2017.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/15/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe and compare outcomes in men with initially presumed indolent prostate cancer receiving definitive radiation therapy after active surveillance (AS) versus those in a risk-matched cohort undergoing up-front radiation therapy. METHODS AND MATERIALS Men prospectively enrolled in an AS program between 1992 and 2014 and subsequently undergoing curative radiation therapy (ie, image guided radiation therapy [IGRT] or low-dose-rate brachytherapy [LDR-BT]) were identified. Biochemical relapse-free rate (bRFR), metastasis-free rate (mFR), and overall survival (OS) were compared against a cohort of men treated up front, matched by age, clinical prognostic indices (risk group, prostate-specific antigen, cT category, Gleason score, percentage of involved biopsy cores), and radiation therapy modality. RESULTS Of 1070 patients in the AS registry, 200 underwent definitive radiation therapy (143 IGRT and 57 LDR-BT) after a median of 32.9 (interquartile range [IQR] 20.6-59.8) months on surveillance. Main reasons for treatment were grade and volume upgrading (57.5% and 26%, respectively). Median follow-up after radiation therapy was 4.9 (IQR 3.1-7.5) years. At 5 years the bRFR, mFR, and OS were, respectively, 97%, 99%, and 98.5%. No patient died of prostate cancer. Adequate risk-matching was confirmed in an independent cohort comprising 359 patients receiving up-front IGRT (71%) or LDR-BT (29%) and followed for a median of 9 (IQR 3.1-7.5) years. There was no difference in the disease-specific outcomes (bRFR, mFR) between the 2 cohorts (Gray's P value of .257 and .934, respectively). In multivariate analyses, timing of radical radiation therapy (deferred vs up-front) was not correlated to biochemical relapse or metastases occurrence. CONCLUSIONS Curative-intent radiation therapy (ie, dose-escalated IGRT or LDR-BT) after a period of AS renders excellent oncologic outcomes at 5 years. Deferring radical therapy after a period of AS does not seem to result in inferior oncologic outcomes compared with patients with similar risk characteristics undergoing up-front treatment.
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Affiliation(s)
- Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Ardalan E Ahmad
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Melvin L K Chua
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Fabio Y Moraes
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Haiyan Jiang
- Department of Biostatistics, Princess Margaret Cancer Centre-University Health Network, Toronto, Ontario, Canada
| | - Maria Komisarenko
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Narhari Trimilshina
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hamid Raziee
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jure Murgic
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Robert G Bristow
- Radiation Medicine Program, Princess Margaret Cancer Centre-University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada.
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16
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Hirasawa Y, Ohori M, Sugihara T, Hashimoto T, Satake N, Gondo T, Nakagami Y, Namiki K, Yoshioka K, Nakashima J, Tachibana M, Ohno Y. No clinical significance of the time interval between biopsy and robotic-assisted radical prostatectomy for patients with clinically localized prostate cancer on biochemical recurrence: a propensity score matching analysis. Jpn J Clin Oncol 2018; 47:1083-1089. [PMID: 28973504 DOI: 10.1093/jjco/hyx125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/16/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose To investigate the impact of the time interval (TI) between prostate biopsy and robot-assisted radical prostatectomy (RARP) on the risk of biochemical recurrence (BCR). Methods We retrospectively reviewed the medical records of 793 consecutive patients who were treated with RARP at our institution. Patients were divided into three groups, according to TI, to compare BCR-free survival (BCRFS) rates: Group 1 (n = 196), TI < 3 months; Group 2 (n = 513), 3 ≤ TI < 6 months; Group 3 (n = 84), TI ≥ 6 months. Eighty-three patients with TI ≥ 6 months were matched with an equal number of patients with TI < 6 months based on propensity scores by using four preoperative factors: prostate-specific antigen (PSA), primary (pGS) and secondary (sGS) Gleason score and positive prostate biopsy. Results The 5-year BCRFS rates for TI Groups 1, 2, and 3 were 76%, 80.7% and 82.6% (P = 0.99), respectively. The multivariate analysis revealed that PSA, pGS, sGS and a positive prostate biopsy were independent preoperative risk factors for BCR. The propensity adjusted 5-year BCRFS for patients with TI ≥ 6 months was 84.0%. This was not worse than that of patients with TI < 6 months (71.0%, P = 0.18). Conclusions In our cohorts, a delay in the time from biopsy to RARP did not significantly affect recurrence. Therefore, hasty treatment decisions are unnecessary for at least 6 months after diagnosis of early prostate cancer.
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Affiliation(s)
| | - Makoto Ohori
- Department of Urology, Tokyo Medical University, Tokyo
| | - Toru Sugihara
- Department of Urology, Tokyo Medical University, Tokyo
| | | | - Naoya Satake
- Department of Urology, Tokyo Medical University, Tokyo
| | - Tatsuo Gondo
- Department of Urology, Tokyo Medical University, Tokyo
| | | | | | | | | | | | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, Tokyo
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17
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Zanaty M, Alnazari M, Ajib K, Lawson K, Azizi M, Rajih E, Alenizi A, Hueber PA, Tolmier C, Meskawi M, Saad F, Pompe RS, Karakiewicz PI, El-Hakim A, Zorn KC. Does surgical delay for radical prostatectomy affect biochemical recurrence? A retrospective analysis from a Canadian cohort. World J Urol 2017; 36:1-6. [PMID: 29052761 DOI: 10.1007/s00345-017-2105-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022] Open
Abstract
AIM We sought to explore the impact of surgical wait time (SWT) to robot-assisted radical prostatectomy (RARP) on biochemical recurrence (BCR). METHOD Retrospective review of a prospectively collected database between 2006 and 2015 was conducted on all RARP cases. SWT was defined as period from prostate biopsy to surgery. Primary outcome was the impact on BCR, which was defined as two consecutive PSA ≥ 0.2 ng/dl, or salvage external beam radiation therapy and/or salvage androgen deprivation therapy. Patients were stratified according to D'Amico risk categories. Univariable analysis (UVA) and multivariable analyses (MVA) with a Cox proportional hazards regression model were used to evaluate the effect of SWT and other predictive factors on BCR, in each D'Amico risk group and on the overall collective sample. RESULTS Patients eligible for analysis were 619. Mean SWT was 153, 169, 150, and 125 days, for overall, low-, intermediate-, and high-risk patients, respectively. Multivariate analysis on the overall cohort did not show a significant relation between SWT and BCR. On subgroup analysis of D'Amico risk group, SWT was positively correlated to BCR for high-risk group (p = 0.001). On threshold analysis, cut-off was found to be 90 days. SWT did not significantly affect BCR on UVA and MVA in the low- and intermediate-risk groups. CONCLUSION Increased delay to surgery could affect the BCR, as there was a positive association in high-risk group. Further studies with longer follow-up are necessary to assess the impact of wait time on BCR, cancer specific survival and overall survival.
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Affiliation(s)
- Marc Zanaty
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Sacré Coeur de Montréal", Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Saint-Luc", Montreal, Canada
| | - Mansour Alnazari
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Sacré Coeur de Montréal", Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Saint-Luc", Montreal, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Sacré Coeur de Montréal", Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Saint-Luc", Montreal, Canada
| | - Kelsey Lawson
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Mounsif Azizi
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Emad Rajih
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Abdullah Alenizi
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Pierre-Alain Hueber
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Côme Tolmier
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Malek Meskawi
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Fred Saad
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Raisa S Pompe
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Pierre I Karakiewicz
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada
| | - Assaad El-Hakim
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada.,Division of Robotic Urology, Department of Surgery, "Hôpital Sacré Coeur de Montréal", Montreal, Canada
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Montreal University, Montreal, Canada. .,Division of Robotic Urology, Department of Surgery, "Hôpital Sacré Coeur de Montréal", Montreal, Canada. .,Division of Robotic Urology, Department of Surgery, "Hôpital Saint-Luc", Montreal, Canada.
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18
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Lim C, Bhangui P, Salloum C, Gómez-Gavara C, Lahat E, Luciani A, Compagnon P, Calderaro J, Feray C, Azoulay D. Impact of time to surgery in the outcome of patients with liver resection for BCLC 0-A stage hepatocellular carcinoma. J Hepatol 2017; 68:S0168-8278(17)32331-0. [PMID: 28989094 DOI: 10.1016/j.jhep.2017.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/24/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend resection for very early and early single hepatocellular carcinoma (HCC) patients. It is not known whether a delay in resection from the time of diagnosis (the time to surgery [TTS], i.e. the elapsed time from diagnosis to surgery) affects outcomes. We aim to evaluate the impact of TTS on recurrence and survival outcomes in patients with HCC. METHODS All patients resected for BCLC stage 0-A single HCC from 2006 to 2016 were studied to evaluate the impact of TTS on recurrence rate, recurrence-free survival (RFS), transplantability following recurrence, and intention-to-treat overall survival (ITT-OS). Propensity score matching (PSM) was further performed to ensure comparability. RESULTS The study population included 100 patients. Surgery was performed between 0.6 and 77 months after diagnosis (median TTS: three months; interquartile range: 1.8-4.6 months). There was no post-operative mortality. Compared to those with TTS <3 months, patients with TTS ≥3 months (70% of these patients had TTS 3-6 months) had a higher post-operative morbidity (36% vs. 16%, p = 0.02), a similar tumor recurrence rate (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), transplantability following tumor recurrence (63% vs. 50%, p = 0.48), and five-year ITT-OS (82% vs. 80%, p = 0.20). Similar results were observed after PSM. CONCLUSION Patients with BCLC stage 0-A single HCC can undergo surgery with TTS ≥3 months without impaired oncologic outcomes. An increase in the TTS within a safe range could allow time for proper evaluation before surgery, and ethical testing of new neoadjuvant treatments, aiming to reduce the high rate of tumor recurrence despite curative resection. LAY SUMMARY A delay of ≥3 months in time to resection after diagnosis in HCC patients meeting the European Association for the Study of Liver Disease/American Association for the Study of Liver Disease criteria for resection does not affect oncological and long-term outcomes compared to those with a delay to surgery of <3 months.
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Affiliation(s)
- Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, New Delhi, India
| | - Chady Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Concepción Gómez-Gavara
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Eylon Lahat
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Alain Luciani
- Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France; Department of Radiology, Henri Mondor Hospital, Créteil, France
| | - Philippe Compagnon
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France
| | - Julien Calderaro
- Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France; Department of Pathology, Henri Mondor Hospital, Créteil, France
| | - Cyrille Feray
- Université Paris-Est UPEC, Créteil, France; Department of Hepatology, Henri Mondor Hospital, Créteil, France
| | - Daniel Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France.
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19
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Ferro M, Lucarelli G, Bruzzese D, Di Lorenzo G, Perdonà S, Autorino R, Cantiello F, La Rocca R, Busetto GM, Cimmino A, Buonerba C, Battaglia M, Damiano R, De Cobelli O, Mirone V, Terracciano D. Low serum total testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for active surveillance. Oncotarget 2017; 8:18424-18434. [PMID: 27793023 PMCID: PMC5392340 DOI: 10.18632/oncotarget.12906] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Active surveillance (AS) is currently a widely accepted treatment option for men with clinically localized prostate cancer (PCa). Several reports have highlighted the association of low serum testosterone levels with high-grade, high-stage PCa. However, the impact of serum testosterone as a predictor of progression in men with low-risk PCa has been little assessed. In this study, we evaluated the association of circulating testosterone concentrations with a staging/grading reclassification in a cohort of low-risk PCa patients meeting the inclusion criteria for the AS protocol but opting for radical prostatectomy. Radical prostatectomy (RP) was performed in 338 patients, eligible for AS according to the following criteria: clinical stage T2a or less, PSA<10ng/ml, two or fewer cancer cores, Gleason score (GS)=6 and PSA density<0.2 ng/mL/cc. Reclassification was defined as upstaging (stage>pT2) and upgrading (GS=7; primary Gleason pattern 4) disease. Unfavorable disease was defined as the occurrence of pathological stage>pT2 and predominant Gleason score 4. Total testosterone was measured before surgery. Low serum testosterone levels (<300 ng/dL) were significantly associated with upgrading, upstaging, unfavorable disease and positive surgical margins. The addition of testosterone to a base model, including age, PSA, PSA density, clinical stage and positive cancer involvement in cores, showed a significant independent influence of this variable on upstaging, upgrading and unfavorable disease. In conclusion, our results support the idea that total testosterone should be a selection criterion for inclusion of low-risk PCa patients in AS programs and suggest that testosterone level less than 300 ng/dL should be considered a discouraging factor when a close AS program is considered as treatment option
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Affiliation(s)
- Matteo Ferro
- Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy
| | - Sisto Perdonà
- Department of Urology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | | | | | - Roberto La Rocca
- Department of Urology, University of Naples 'Federico II', Naples, Italy
| | | | - Amelia Cimmino
- Institute of Genetics and Biophysics "A. Buzzati Traverso", National Research Council, Naples, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy
| | - Michele Battaglia
- Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Rocco Damiano
- Division of Urology, Magna Graecia University, Catanzaro, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy.,University of Milan, Milan, Italy.,University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Vincenzo Mirone
- Department of Urology, University of Naples 'Federico II', Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples 'Federico II', Naples, Italy
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Leyh-Bannurah SR, Karakiewicz PI, Dell'Oglio P, Briganti A, Schiffmann J, Pompe RS, Sauter G, Schlomm T, Heinzer H, Huland H, Graefen M, Budäus L. Comparison of 11 Active Surveillance Protocols in Contemporary European Men Treated With Radical Prostatectomy. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30246-X. [PMID: 28942009 DOI: 10.1016/j.clgc.2017.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/03/2017] [Accepted: 08/12/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aim of this study was to compare 11 active surveillance (AS) protocols in contemporary European men treated with radical prostatectomy (RP) at the Martini-Clinic Prostate Cancer Center. PATIENTS AND METHODS Analyzed were 3498 RP patients, from 2005 to 2016, who underwent ≥ 10 core biopsies and fulfilled at least 1 of 11 examined AS entry definitions. We tested proportions of AS eligibility, ineligibility, presence of primary Gleason 4/5, upstage, and combinations thereof at RP, as well as 5-year biochemical recurrence-free survival (BFS). RESULTS The most and least stringent criteria were very low risk National Comprehensive Cancer Network and Royal Marsden with 18.8% and 96.1% of AS-eligible patients, respectively. Rates of primary Gleason 4/5 at RP, upstaging, or both features, respectively, ranged from 2.3% to 6.7%, 6.1% to 18.2%, and 7.1% to 21.0% for those 2 AS entry definitions. The range of individuals deemed AS-ineligible between the same 2 AS entry definitions, despite not harboring unfavorable pathology (primary Gleason pattern 4/5, upstage, or both), was 80.3% to 3.7%, 78.3% to 3.4%, and 77.8% to 3.4%, respectively. BFS rates showed narrow variability, with a range of 85.9% to 91.8%. CONCLUSION Use of stringent AS entry definitions reduces the number of AS-eligible patients, which is related to a select range in individual entry parameters. Moreover, rates of unfavorable pathology at RP as much as tripled between most and least stringent AS entry definitions. However, less stringent AS entry definitions result in the lowest AS-ineligibility rates, in men without unfavorable pathology. BFS rates were virtually invariably high. Clinicians should know differences in key parameters underlying each AS entry definition, associated effect on rates of eligibility, and potential misclassification of individuals.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Paolo Dell'Oglio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Raisa S Pompe
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Ploussard G, Hennequin C, Rozet F. [Active surveillance of prostate cancer]. Cancer Radiother 2017; 21:437-441. [PMID: 28847461 DOI: 10.1016/j.canrad.2017.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
Several prospective studies have demonstrated the safety of active surveillance as a first treatment of prostate cancer. It spares many patients of a useless treatment, with its potential sequelae. Patients with a low-risk cancer are all candidates for this approach, as recommended by the American Society of Clinical Oncology (ASCO). Some patients with an intermediate risk could be also concerned by active surveillance, but this is still being discussed. Currently, the presence of grade 4 lesions on biopsy is a contra-indication. Modalities included a repeated prostate specific antigen test and systematic rebiopsy during the first year after diagnosis. MRI is now proposed to better select patients at inclusion and also during surveillance. No life style changes or drugs are significantly associated with a longer duration of surveillance.
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Affiliation(s)
- G Ploussard
- Clinique Saint-Jean-du-Languedoc, 20, route de Revel, 31400 Toulouse, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France
| | - F Rozet
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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22
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Zanaty M, Alnazari M, Lawson K, Azizi M, Rajih E, Alenizi A, Hueber PA, Meskawi M, Lebacle C, Lebeau T, Benayoun S, Karakiewicz PI, El-Hakim A, Zorn KC. Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort. Can Urol Assoc J 2017; 11:265-269. [PMID: 28798829 DOI: 10.5489/cuaj.4149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to assess the impact of surgical wait time (SWT) to robot-assisted radical prostatectomy (RARP) on final pathological outcome. METHODS A retrospective review of RARP patient records operated between 2006 and 2015 was conducted. SWT was defined as period from prostate biopsy to surgery. Primary outcome was the impact on postoperative Cancer of the Prostate Risk Assessment (CAPRA-S) score. Patients were stratified according to D'Amico risk categories. Univariate analysis (UVA) and multivariable (MVA) analysis with a generalized linear model was used to evaluate the effect of SWT and other predictive factors on pathological outcome in individual risk group and on the overall sample. RESULTS A total of 835 patients were eligible for analysis. Mean SWT was significantly different between the three D'Amico groups, with mean SWT of 180.22 days (95% confidence interval [CI] 169.03; 191.41), 159.14 days (95% CI 152.38; 165.90), and 138.96 days (95% CI 124.60; 153.33) for low-, intermediate-, and high-risk groups, respectively (p<0.001). After stratification by D'Amico risk group, no significant association was observed between SWT and CAPRA-S score in the three risk categories on UVA and MVA. Predictors of higher CAPRA-S score in the multivariable model in the overall cohort were: older age (p=0.014), biopsy Gleason score (p<0.001), percentage of positive cores (p<0.001), and clinical stage (p<0.001). CONCLUSIONS In the present study evaluating SWT for RARP in a Canadian socialized system, increased delay for surgery does not appear to impact the pathological outcome. Further studies are required to evaluate the impact of wait time on biochemical recurrence-free survival, cancer-specific survival, and overall survival.
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Affiliation(s)
- Marc Zanaty
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Mansour Alnazari
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Kelsey Lawson
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Mounsif Azizi
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Emad Rajih
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Abdullah Alenizi
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Malek Meskawi
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Cedric Lebacle
- Department of Urology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Thierry Lebeau
- Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Serge Benayoun
- Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Pierre I Karakiewicz
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Assaad El-Hakim
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
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23
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Abstract
OBJECTIVES The purpose of the guidelines national committee CCAFU was to propose updated french guidelines for localized and metastatic prostate cancer (PCa). METHODS A Medline search was achieved between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of PCa, to evaluate different references with levels of evidence. RESULTS Epidemiology, classification, staging systems, diagnostic evaluation are reported. Disease management options are detailed. Recommandations are reported according to the different clinical situations. Active surveillance is a major option in low risk PCa. Radical prostatectomy remains a standard of care of localized PCa. The three-dimensional conformal radiotherapy is the technical standard. A dose of > 74Gy is recommended. Moderate hypofractionation provides short-term biochemical control comparable to conventional fractionation. In case of intermediate risk PCa, radiotherapy can be combined with short-term androgen deprivation therapy (ADT). In case of high risk disease, long-term ADT remains the standard of care. ADT is the backbone therapy of metastatic disease. In men with metastases at first presentation, upfront chemotherapy combined with ADT should be considered as a new standard. In case of metastatic castration-resistant PCa (mCRPC), new hormonal treatments and chemotherapy provide a better control of tumor progression and increase survival. CONCLUSIONS These updated french guidelines will contribute to increase the level of urological care for the diagnosis and treatment for prostate cancer. © 2016 Elsevier Masson SAS. All rights reserved.
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[Prevalence and diversity of management of prostate cancer patients classified as low risk using D'Amico group or Cancer of the Prostate Risk Assessment (CAPRA) score: A French multicenter study]. Prog Urol 2017; 27:158-165. [PMID: 28258910 DOI: 10.1016/j.purol.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Currently, the French High Authority for Health does not recommend mass screening for prostate cancer (PCa), due to the risk of over-treatment, notably of low risk patients. Our study is intended to reflect the therapeutic attitudes for the management of patients classified as low risk of progression in French clinical centers. METHODS For all positive prostate biopsies performed during 2012 and 2013 in five French departments of urology, clinicopathological characteristics required to calculate the d'Amico risk group and the Cancer of the Prostate Risk Assessment (CAPRA) score were filled. Information on the first treatment of "low risk" patients was collected. RESULTS A total of 1035 patients were included, with a median age at diagnosis of 66 years old. According to d'Amico and CAPRA classifications, 30.4% and 35.0% of patients were at low, 34.5% and 33.2% at intermediate, 35.1% and 31.8% at high risk. The diagnosis severity increased with age (P<0.0001). The main treatment for low risk patients was radical prostatectomy (41.6% and 42.0% for d'Amico and CAPRA, respectively), but active surveillance was the most frequent treatment if diagnosed after 75 years old. The management of low risk patients varied significantly between centers (P<0.0001), according to the therapeutic platforms available within the hospital. CONCLUSIONS In absence of strong progression predictor, the management of low risk PCa remains based on center habits and local therapeutic platforms. New predictive markers, such as multiparametric MRI or molecular tests, are needed to guide rational management of low risk PCa. LEVEL OF EVIDENCE 4.
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25
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Prostate cancer outcomes and delays in care. Int Urol Nephrol 2017; 49:449-455. [PMID: 28083860 DOI: 10.1007/s11255-017-1508-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/06/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To examine the survival effect of treatment delays from the time of confirmed diagnosis of prostate cancer to first treatment in an Australian population. METHODS Three thousand one hundred and forty patients were identified from the South Australian Prostate Cancer Clinical Outcomes Collaborative database for analysis. Selected patients had dates recorded for both diagnosis and treatment. We examined the effect of treatment delay (the time from diagnosis to date of first treatment) on survival using Cox and competing risks regression and compared quartiles of delay across the cohort. Adjustment was made for age, PSA levels, treatment modality and Gleason score. Outcomes included overall survival (OS) and prostate cancer-specific mortality (PCSM). RESULTS Quartiles of delay were as follows (days)-Q1: 35, Q2: 86, Q3: 138.0, Q4: 264. Shorter delays were associated with hormonal treatment, high Gleason score and high PSA values. Measuring PCSM with Q2 as reference, age-adjusted associations were-Q1: sHR 4.37 (2.75-6.94), Q3: sHR 1.29 (0.73-2.28), Q4: sHR 1.55 (0.91-2.63). After additional adjustment for treatment type, Gleason score and PSA, Q1 remained at increased risk [sHR 2.46 (1.10-5.54)]. A similar trend was observed for OS. In analysis stratified by Gleason score, delays were not significantly associated with OS. CONCLUSIONS Factors associated with shorter delay in treatment include high Gleason score, high PSA and hormonal treatment. After adjustment for these variables, increased delays were not associated with OS or PCSM in this cohort. The nonlinear association of delay with risk may explain conflicting reports in the literature.
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26
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Expectant Management for Prostate Cancer: Lessons from the Past, Challenges for the Future. Eur Urol 2016; 70:767-768. [DOI: 10.1016/j.eururo.2016.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 11/21/2022]
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27
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Loeb S, Folkvaljon Y, Robinson D, Makarov DV, Bratt O, Garmo H, Stattin P. Immediate versus delayed prostatectomy: Nationwide population-based study (.). Scand J Urol 2016; 50:246-54. [PMID: 27067998 PMCID: PMC4979613 DOI: 10.3109/21681805.2016.1166153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/11/2016] [Indexed: 01/12/2023]
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.
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Affiliation(s)
- Stacy Loeb
- a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA
| | - Yasin Folkvaljon
- b Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital , Uppsala , Sweden
| | - David Robinson
- c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden
- d Department of Urology , Ryhov County Hospital , Jönköping , Sweden
| | - Danil V Makarov
- a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA
| | - Ola Bratt
- e Department of Urology, CamPARI Clinic , Addenbrooke's Hospital , Cambridge , UK
- f Department of Translational Sciences , Lund University , Lund , Sweden
| | - Hans Garmo
- g Faculty of Life Sciences and Medicine, Division of Cancer Studies , King's College London , London , UK
| | - Pär Stattin
- c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden
- h Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
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Tosoian JJ, Sundi D, Trock BJ, Landis P, Epstein JI, Schaeffer EM, Carter HB, Mamawala M. Pathologic Outcomes in Favorable-risk Prostate Cancer: Comparative Analysis of Men Electing Active Surveillance and Immediate Surgery. Eur Urol 2016; 69:576-581. [DOI: 10.1016/j.eururo.2015.09.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
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Effects of Time to Treatment on Biochemical and Clinical Outcomes for Patients With Prostate Cancer Treated With Definitive Radiation. Clin Genitourin Cancer 2016; 14:e463-e468. [PMID: 26935996 DOI: 10.1016/j.clgc.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/25/2016] [Accepted: 01/31/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate if time to treatment (TTT) has an effect on outcomes for patients with localized prostate cancer treated with definitive external beam radiation therapy (EBRT). PATIENTS AND METHODS We included 4064 patients (1549 low-risk, 1612 intermediate-risk, and 903 high-risk) treated with EBRT. For each National Comprehensive Cancer Network (NCCN) risk group, TTT (defined as the time between initial positive prostate biopsy and start of RT) was analyzed in 4 intervals: < 3, 3-6, 6-9, and 9-24 months. We recorded the use of androgen deprivation therapy among patients with intermediate-risk and high-risk disease. RESULTS The median TTT was 3.3 months (range, 0.6-23.5 months), and it was similar for each risk group (range, 3.3-3.4 months). The median follow up was 64 months. There were no significant differences in biochemical failure, distant metastasis, or overall survival for patients with TTT < 3, 3-6, 6-9, or 9-24 months for each risk group. There were also no significant differences in the outcomes at 5 years when patients with TTT > 3.3 months were compared with those with TTT ≤ 3.3 months for each risk group. For high-risk men, 328 of 450 (72.9%) with TTT > 3.3 months were on androgen deprivation therapy (ADT) versus 299 of 453 (66%) with TTT ≤ 3.3 months. Among men with high-risk cancer treated without ADT, there remained no significant difference in outcomes between TTT > 3.3 months and TTT ≤ 3.3 months. CONCLUSION TTT was not associated with significant differences in outcomes among each risk group of men with localized prostate cancer treated with EBRT. Among the high-risk patients, there were no observed detriments in outcomes with TTT > 3.3 months regardless of androgen deprivation therapy use.
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Abstract
Autopsy studies have confirmed the high prevalence of latent prostate cancer; however, only a certain portion of patients require definite treatment. Active surveillance is one of the treatment options which, according to national and international guidelines, should be offered to patients with newly diagnosed low-risk prostate cancer. Prostate cancer-specific survival is high in these patients; therefore, curative treatment, such as radical prostatectomy, external beam radiotherapy and brachytherapy may be initially deferred in order to avoid therapy-related side effects. In order to qualify for active surveillance, strict inclusion criteria have to be met; nevertheless, the reliable identification of low-risk prostate cancer patients is not always possible. Patients under active surveillance are followed up regularly with prostate-specific antigen (PSA) testing, digital rectal examination (DRE) and repeat prostate biopsies. Due to the heterogeneity of primary prostate tumors precise molecular diagnostic techniques could allow individualized treatment strategies in the future.
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Affiliation(s)
- Annika Herlemann
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland.
| | - Christian G Stief
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland
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31
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Adeniran AJ, Humphrey PA. Morphologic Updates in Prostate Pathology. Surg Pathol Clin 2015; 8:539-60. [PMID: 26612214 DOI: 10.1016/j.path.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the past several years, modifications have been made to the original Gleason system with resultant therapeutic and prognostic implications. Several morphologic variants of prostatic adenocarcinoma have also been described. Prostate pathology has also evolved over the years with the discovery and utility of new immunohistochemical stains. The topics discussed in this update include the Gleason grading system, prognostic grade grouping, variants of prostatic adenocarcinoma, and the application of immunohistochemistry to prostate pathology.
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Affiliation(s)
- Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06520, USA.
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06520, USA
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32
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Reese AC, Feng Z, Landis P, Trock BJ, Epstein JI, Carter HB. Predictors of Adverse Pathology in Men Undergoing Radical Prostatectomy Following Initial Active Surveillance. Urology 2015; 86:991-5. [DOI: 10.1016/j.urology.2015.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/28/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
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33
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Filippou P, Welty CJ, Cowan JE, Perez N, Shinohara K, Carroll PR. Immediate Versus Delayed Radical Prostatectomy: Updated Outcomes Following Active Surveillance of Prostate Cancer. Eur Urol 2015; 68:458-63. [DOI: 10.1016/j.eururo.2015.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
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34
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Anderson CB, Tin AL, Sjoberg DD, Mulhall JP, Sandhu J, Touijer K, Laudone VP, Eastham JA, Scardino PT, Ehdaie B. Association between number of prostate biopsies and patient-reported functional outcomes after radical prostatectomy: implications for active surveillance protocols. BJU Int 2015; 117:E46-51. [PMID: 26118438 DOI: 10.1111/bju.13215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate whether the number of preoperative prostate biopsies affects functional outcomes after radical prostatectomy (RP). METHODS We identified patients treated with RP at our institution between 2008 and 2011. At 6 and 12 months postoperatively, the patients completed questionnaires assessing erectile and urinary function. Patients with preoperative incontinence or erectile dysfunction or who did not complete the questionnaire were excluded. Primary outcomes were urinary and erectile function at 12 months postoperatively. We used logistic regression to estimate the impact of number of prostate biopsies on functional outcomes after adjusting for demographic and clinical factors. RESULTS We identified 2 712 patients treated with RP between 2008 and 2011. Most of the patients (80%) had one preoperative prostate biopsy, 16% had two, and 4% had at least three. On adjusted analysis, erectile function at 12 months was not significantly different for patients with two (odds ratio [OR] 1.25; 95% confidence interval [CI] 0.90, 1.75) or three or more (OR 1.52; 95% CI 0.84, 2.78) biopsies, compared with those with one biopsy. Similarly, urinary function at 12 months was not significantly different for patients with two (0.84, 95% CI 0.64, 1.10) or three or more (0.99, 95% CI 0.60, 1.61) biopsies compared with those with one. CONCLUSIONS We did not find evidence that a greater number of preoperative prostate biopsies adversely affected erectile or urinary function at 12 months after RP.
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Affiliation(s)
- Christopher B Anderson
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaspreet Sandhu
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karim Touijer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vincent P Laudone
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A Eastham
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Behfar Ehdaie
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Berg WT, Danzig MR, Pak JS, Korets R, RoyChoudhury A, Hruby G, Benson MC, McKiernan JM, Badani KK. Delay from biopsy to radical prostatectomy influences the rate of adverse pathologic outcomes. Prostate 2015; 75:1085-91. [PMID: 25809289 DOI: 10.1002/pros.22992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/13/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND We sought to determine maximum wait times between biopsy diagnosis and surgery for localized prostate cancer, beyond which the rate of adverse pathologic outcomes is increased. METHODS We retrospectively reviewed 4,610 patients undergoing radical prostatectomy between 1990 and 2011. Patients were stratified by biopsy Gleason score and PSA value. For each stratification, χ2 analysis was used to determine the smallest 15-day multiple of surgical delay (e.g., 15, 30, 45…180 days) for which adverse pathologic outcomes were significantly more likely after the time interval than before. Adverse outcomes were defined as positive surgical margins, upgrading from biopsy, upstaging, seminal vesicle invasion, or positive lymph nodes. RESULTS Two thousand two hundred twelve patients met inclusion criteria. Median delay was 64 days (mean 76, SD 47). One thousand six hundred seventy-five (75.7%), 537 (24.3%), and 60 (2.7%) patients had delays of <=90, >90, and >180 days, respectively. Twenty-six percent were upgraded on final pathology and 23% were upstaged. The positive surgical margin rate was 24.2% and the positive lymph node rate was 1.1%. Significant increases in the proportion of adverse pathological outcomes were found beyond 75 days in the overall cohort (P = 0.03), 150 days for patients with Gleason <=6, and PSA 0-10 (P = 0.038), 60 days for patients with Gleason 7 and PSA >20 (P = 0.032), and 30 days for patients with Gleason 8-10 and PSA 11-20 (0.041). CONCLUSION In low-risk disease, there is a considerable but not unlimited surgical delay which will not adversely impact the rate of adverse pathologic features found. In higher risk disease, this time period is considerably shorter.
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Affiliation(s)
- William T Berg
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew R Danzig
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jamie S Pak
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ruslan Korets
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Gregory Hruby
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mitchell C Benson
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - James M McKiernan
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ketan K Badani
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
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Hussein AA, Welty CJ, Ameli N, Cowan JE, Leapman M, Porten SP, Shinohara K, Carroll PR. Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes. J Urol 2015; 194:85-90. [PMID: 25623742 DOI: 10.1016/j.juro.2015.01.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE We describe the outcomes of patients with low risk localized prostate cancer who were upgraded on a surveillance biopsy while on active surveillance and evaluated whether delayed treatment was associated with adverse outcome. MATERIALS AND METHODS We included men in the study with lower risk disease managed initially with active surveillance and upgraded to Gleason score 3+4 or greater. Patient demographics and disease characteristics were compared. Kaplan-Meier curve was used to estimate the treatment-free probability stratified by initial upgrade (3+4 vs 4+3 or greater), Cox regression analysis was used to examine factors associated with treatment and multivariate logistic regression analysis was used to evaluate the factors associated with adverse outcome at surgery. RESULTS The final cohort comprised 219 men, with 150 (68%) upgraded to 3+4 and 69 (32%) to 4+3 or greater. Median time to upgrade was 23 months (IQR 11-49). A total of 163 men (74%) sought treatment, the majority (69%) with radical prostatectomy. The treatment-free survival rate at 5 years was 22% for 3+4 and 10% for 4+3 or greater upgrade. Upgrade to 4+3 or greater, higher prostate specific antigen density at diagnosis and shorter time to initial upgrade were associated with treatment. At surgical pathology 34% of cancers were downgraded while 6% were upgraded. Cancer volume at initial upgrade was associated with adverse pathological outcome at surgery (OR 3.33, 95% CI 1.19-9.29, p=0.02). CONCLUSIONS After Gleason score upgrade most patients elected treatment with radical prostatectomy. Among men who deferred definitive intervention, few experienced additional upgrading. At radical prostatectomy only 6% of cases were upgraded further and only tumor volume at initial upgrade was significantly associated with adverse pathological outcome.
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Affiliation(s)
- A A Hussein
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; Department of Urology, Cairo University, Cairo, Egypt
| | - C J Welty
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - N Ameli
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - J E Cowan
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - M Leapman
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - S P Porten
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - K Shinohara
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - P R Carroll
- Department of Urology and UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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Rozet F, Bastide C, Beuzeboc P, Cormier L, Fromont G, Hennequin C, Mongiat-Artus P, Peyromaure M, Renard-Penna R, Richaud P, Salomon L, Soulié M. Prise en charge des tumeurs de la prostate à faible risque évolutif. Prog Urol 2015; 25:1-10. [DOI: 10.1016/j.purol.2014.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 10/10/2014] [Accepted: 10/18/2014] [Indexed: 11/15/2022]
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Hong SK, Sternberg IA, Keren Paz GE, Kim PH, Touijer KA, Scardino PT, Eastham JA. Definitive Pathology at Radical Prostatectomy Is Commonly Favorable in Men Following Initial Active Surveillance. Eur Urol 2014; 66:214-9. [DOI: 10.1016/j.eururo.2013.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/01/2013] [Indexed: 12/23/2022]
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Lim SK, Kim KH, Shin TY, Chung BH, Hong SJ, Choi YD, Rha KH. Yonsei Criteria: A New Protocol for Active Surveillance in the Era of Robotic and Local Ablative Surgeries. Clin Genitourin Cancer 2013; 11:501-7. [DOI: 10.1016/j.clgc.2013.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/04/2013] [Accepted: 04/17/2013] [Indexed: 11/27/2022]
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O'Kelly F, Thomas A, Murray D, Galvin D, Mulvin D, Quinlan DM. Can delayed time to referral to a tertiary level urologist with an abnormal PSA level affect subsequent Gleason grade in the opportunistically screened population? Prostate 2013; 73:1263-9. [PMID: 23657938 DOI: 10.1002/pros.22628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/14/2012] [Indexed: 11/07/2022]
Abstract
PURPOSE There is growing conflict in the literature describing the effect of delayed treatment on outcomes following radical prostatectomy. There is also evidence to suggest progression of low-risk prostate cancer to develop higher grades and volumes of prostate cancer during active surveillance. It is unknown as to what affect a delay in referral of those men with abnormal screened-PSA levels have on subsequent Gleason grade. METHODS We identified 350 men through our rapid access prostate clinic who underwent TRUS biopsy for abnormal age-related PSA and/or abnormal clinical examination. Clinicopathological findings were compared for those with positive versus negative TRUS biopsies, and for those with initial delays in referral (<12 months, 12-18 months, and >18 months). We used ANOVA and Student's t-tests amongst other statistical tools to examine significance of clinical findings. RESULTS Of the 350 men who underwent TRUS biopsy, those with a delay in referral of 12 months or more were significantly associated with higher PSA titers, clinically palpable disease and likelihood of diagnosis with prostate cancer. A delay of 18 months or more led to a significantly higher risk of being diagnosed with a leading grade 4 prostate cancer, which was further supported using PSA velocity as a diagnostic tool (change >0.4 ng/ml/year). CONCLUSION We recommend that repeated asymptomatic abnormal age-related PSA readings and/or abnormal clinical examination in the screened population be referred without delay to a urologist for further assessment, enrolment into an active surveillance program or definitive subsequent treatment.
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Affiliation(s)
- Fardod O'Kelly
- Department of Urological Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland.
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Rice KR, Colombo ML, Wingate J, Chen Y, Cullen J, McLeod DG, Brassell SA. Low risk prostate cancer in men ≥ 70 years old: To treat or not to treat. Urol Oncol 2013; 31:755-60. [DOI: 10.1016/j.urolonc.2011.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/05/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
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Carter HB. Active surveillance for prostate cancer: an underutilized opportunity for reducing harm. J Natl Cancer Inst Monogr 2013; 2012:175-83. [PMID: 23271770 DOI: 10.1093/jncimonographs/lgs036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The management of localized prostate cancer is controversial, and in the absence of comparative trials to inform best practice, choices are driven by personal beliefs with wide variation in practice patterns. Men with localized disease diagnosed today often undergo treatments that will not improve overall health outcomes, and active surveillance has emerged as one approach to reducing this overtreatment of prostate cancer. The selection of appropriate candidates for active surveillance should balance the risk of harm from prostate cancer without treatment, and a patient's personal preferences for living with a cancer and the potential side effects of curative treatments. Although limitations exist in assessing the potential for a given prostate cancer to cause harm, the most common metrics used today consider cancer stage, prostate biopsy features, and prostate-specific antigen level together with the risk of death from nonprostate causes based on age and overall state of health.
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Affiliation(s)
- H Ballentine Carter
- Department of Urology, Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD 21287-2101, USA.
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Carlsson S, Maschino A, Schröder F, Bangma C, Steyerberg EW, van der Kwast T, van Leenders G, Vickers A, Lilja H, Roobol MJ. Predictive value of four kallikrein markers for pathologically insignificant compared with aggressive prostate cancer in radical prostatectomy specimens: results from the European Randomized Study of Screening for Prostate Cancer section Rotterdam. Eur Urol 2013; 64:693-9. [PMID: 23683475 DOI: 10.1016/j.eururo.2013.04.040] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/22/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment decisions can be difficult in men with low-risk prostate cancer (PCa). OBJECTIVE To evaluate the ability of a panel of four kallikrein markers in blood-total prostate-specific antigen (PSA), free PSA, intact PSA, and kallikrein-related peptidase 2-to distinguish between pathologically insignificant and aggressive disease on pathologic examination of radical prostatectomy (RP) specimens as well as to calculate the number of avoidable surgeries. DESIGN, SETTING, AND PARTICIPANTS The cohort comprised 392 screened men participating in rounds 1 and 2 of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer. Patients were diagnosed with PCa because of an elevated PSA ≥3.0 ng/ml and were treated with RP between 1994 and 2004. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We calculated the accuracy (area under the curve [AUC]) of statistical models to predict pathologically aggressive PCa (pT3-T4, extracapsular extension, tumor volume >0.5cm(3), or any Gleason grade ≥4) based on clinical predictors (age, stage, PSA, biopsy findings) with and without levels of four kallikrein markers in blood. RESULTS AND LIMITATIONS A total of 261 patients (67%) had significant disease on pathologic evaluation of the RP specimen. While the clinical model had good accuracy in predicting aggressive disease, reflected in a corrected AUC of 0.81, the four kallikrein markers enhanced the base model, with an AUC of 0.84 (p < 0.0005). The model retained its ability in patients with low-risk and very-low-risk disease and in comparison with the Steyerberg nomogram, a published prediction model. Clinical application of the model incorporating the kallikrein markers would reduce rates of surgery by 135 of 1000 patients overall and 110 of 334 patients with pathologically insignificant disease. A limitation of the present study is that clinicians may be hesitant to make recommendations against active treatment on the basis of a statistical model. CONCLUSIONS Our study provided proof of principle that predictions based on levels of four kallikrein markers in blood distinguish between pathologically insignificant and aggressive disease after RP with good accuracy. In the future, clinical use of the model could potentially reduce rates of immediate unnecessary active treatment.
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Affiliation(s)
- Sigrid Carlsson
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Iremashvili V, Burdick-Will J, Soloway MS. Improving risk stratification in patients with prostate cancer managed by active surveillance: a nomogram predicting the risk of biopsy progression. BJU Int 2013; 112:39-44. [PMID: 23551868 DOI: 10.1111/bju.12112] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a clinical tool that integrates different risk factors and provides individual predictions of the risk of biopsy progression in patients with prostate cancer managed by active surveillance. MATERIALS AND METHODS Our analysis included 205 patients on active surveillance, each of whom had had at least two surveillance biopsies. We used the Cox proportional hazard regression model to analyse the association between different risk factors and progression-free survival over successive biopsies. This multivariate model was then used to develop a nomogram. Discrimination and calibration of the nomogram were internally validated using 200 bootstrap resamplings. RESULTS The median follow-up of patients free of progression was 4.6 years. A total of 58 (28%) patients experienced progression. Factors significantly associated with progression were: overall number of positive cores in the diagnostic and first surveillance biopsies, race and prostate-specific antigen density. The bootstrapping concordance index of the nomogram including these variables was 81%. The nomogram tended to underestimate the probability of progression but it identified fairly accurately the distinct groups of patients at low, intermediate and high risk of progression. CONCLUSIONS In the development cohort, the nomogram was able to separate patients with respect to their risk of biopsy progression. Since accurate risk stratification is essential to optimize patient care, this tool, if external validation confirms its performance, may prove useful for both the counselling and management of patients with low-volume, Gleason 6 prostate cancer.
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Affiliation(s)
- Viacheslav Iremashvili
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA.
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Potential Consequences of Low Biopsy Core Number in Selection of Patients With Prostate Cancer for Current Active Surveillance Protocols. Urology 2013; 81:837-42. [DOI: 10.1016/j.urology.2012.10.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 09/24/2012] [Accepted: 10/15/2012] [Indexed: 11/24/2022]
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Shin DW, Cho J, Kim SY, Guallar E, Hwang SS, Cho B, Oh JH, Jung KW, Seo HG, Park JH. Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer. Ann Surg Oncol 2013; 20:2468-76. [PMID: 23529782 DOI: 10.1245/s10434-013-2957-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgery for cancer is often delayed due to variety of patient-, provider-, and health system-related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival. METHODS Cohort study based on representative sample of patients (n = 7,529) with colorectal, breast, lung and thyroid cancer with local or regional disease who underwent potentially curative surgery as their first therapeutic modality within 1 year of cancer diagnosis. They were diagnosed in 2006 and followed for mortality until April 2011, a median follow-up of 4.7 years. RESULTS For colorectal and breast cancers, the adjusted hazard ratios (95 % confidence intervals) for all-cause mortality comparing a surgical delay beyond 12 weeks to performing surgery within weeks 1-4 after diagnosis were 2.65 (1.50-4.70) and 1.91 (1.06-3.49), respectively. No clear pattern of increased risk was observed with delays between 4 and 12 weeks, or for any delay in lung and thyroid cancers. Concordance between the area of the patient's residence and the hospital performing surgery, and the patient's income status were associated with delayed surgery. CONCLUSIONS Delays to curative surgery beyond 12 weeks were associated with increased mortality in colorectal and breast cancers, suggesting that health provision services should be organized to avoid unnecessary treatment delays. Health care systems should also aim to reduce socioeconomic and geographic disparities and to guarantee equitable access to high quality cancer care.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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Impact of the length of time between diagnosis and surgical removal of urologic neoplasms on survival. World J Urol 2013; 32:475-9. [PMID: 23455886 DOI: 10.1007/s00345-013-1045-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/18/2013] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Our aim was to assess the effect of surgical wait time on the survival of patients with urological neoplasms, including prostate, bladder, penile, and testicular cancers and upper tract tumours (UTUC). MATERIALS AND METHODS Current, relevant studies were identified from the literature. Keywords used for article retrieval were as follows: delay; surgery; prostate cancer; urothelial carcinoma; renal cell carcinoma; testicular cancer; bladder; renal pelvis; ureter; and survival. RESULTS Regarding the length of surgical wait time, it does not matter in cases of incidental T1a renal cell carcinomas. In other cases of renal cell carcinomas, surgery should be considered within <1 month; it is of crucial importance in bladder cancer and should be <1 month for a TURBT in cases of non-muscle-invasive bladder cancer and <1 month for a radical cystectomy in cases of muscle-invasive bladder cancer; it is important in invasive UTUC and should be <1 month for a radical nephroureterectomy; it is not crucial in cases of low-risk prostate cancer. In any other case, radical prostatectomy should be considered within <2 months; it is important in testicular cancer and should be fewer than 10 days for an orchiectomy. CONCLUSION Prolonged surgical wait times have an impact on the overall quality of life and anxiety of the patient. Extending the wait time beyond a given threshold can also have a negative impact on the patient's clinical outcomes, but this threshold differs between urological neoplasms.
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Abern MR, Aronson WJ, Terris MK, Kane CJ, Presti JC, Amling CL, Freedland SJ. Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database. Prostate 2013; 73:409-17. [PMID: 22996686 DOI: 10.1002/pros.22582] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/16/2012] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Active surveillance (AS) is increasingly accepted as appropriate management for low-risk prostate cancer (PC) patients. It is unknown whether delaying radical prostatectomy (RP) is associated with increased risk of biochemical recurrence (BCR) for men with intermediate-risk PC. METHODS We performed a retrospective analysis of 1,561 low and intermediate-risk men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with RP between 1988 and 2011. Patients were stratified by interval between diagnosis and RP (≤ 3, 3-6, 6-9, or >9 months) and by risk using the D'Amico classification. Cox proportional hazard models were used to analyze BCR. Logistic regression was used to analyze positive surgical margins (PSM), extracapsular extension (ECE), and pathologic upgrading. RESULTS Overall, 813 (52%) men were low-risk, and 748 (48%) intermediate-risk. Median follow-up among men without recurrence was 52.9 months, during which 437 men (38.9%) recurred. For low-risk men, RP delays were unrelated to BCR, ECE, PSM, or upgrading (all P > 0.05). For intermediate-risk men, however, delays >9 months were significantly related to BCR (HR: 2.10, P = 0.01) and PSM (OR: 4.08, P < 0.01). Delays >9 months were associated with BCR in subsets of intermediate-risk men with biopsy Gleason score ≤ 3 + 4 (HR: 2.51, P < 0.01), PSA ≤ 6 (HR: 2.82, P = 0.06), and low tumor volume (HR: 2.59, P = 0.06). CONCLUSIONS For low-risk men, delayed RP did not significantly affect outcome. For men with intermediate-risk disease, delays >9 months predicted greater BCR and PSM risk. If confirmed in future studies, this suggests delayed RP for intermediate-risk PC may compromise outcomes.
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Affiliation(s)
- Michael R Abern
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27705, USA.
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van den Bergh RCN, Albertsen PC, Bangma CH, Freedland SJ, Graefen M, Vickers A, van der Poel HG. Timing of curative treatment for prostate cancer: a systematic review. Eur Urol 2013; 64:204-15. [PMID: 23453419 DOI: 10.1016/j.eururo.2013.02.024] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
CONTEXT Delaying definitive therapy unfavourably affects outcomes in many malignancies. Diagnostic, psychological, and logistical reasons but also active surveillance (AS) strategies can lead to treatment delay, an increase in the interval between the diagnosis and treatment of prostate cancer (PCa). OBJECTIVE To review and summarise the current literature on the impact of treatment delay on PCa oncologic outcomes. EVIDENCE ACQUISITION A comprehensive search of PubMed and Embase databases until 30 September 2012 was performed. Studies comparing pathologic, biochemical recurrence (BCR), and mortality outcomes between patients receiving direct and delayed curative treatment were included. Studies presenting single-arm results following AS were excluded. EVIDENCE SYNTHESIS Seventeen studies were included: 13 on radical prostatectomy, 3 on radiation therapy, and 1 combined both. A total of 34 517 PCa patients receiving radical local therapy between 1981 and 2009 were described. Some studies included low-risk PCa only; others included a wider spectrum of disease. Four studies found a significant effect of treatment delay on outcomes in multivariate analysis. Two included low-risk patients only, but it was unknown whether AS was applied or repeat biopsy triggered active therapy during AS. The two other studies found a negative effect on BCR rates of 2.5-9 mo delay in higher risk patients (respectively defined as any with T ≥ 2b, prostate-specific antigen >10, Gleason score >6, >34-50% positive cores; or D'Amico intermediate risk-group). All studies were retrospective and nonrandomised. Reasons for delay were not always clear, and time-to-event analyses may be subject to bias. CONCLUSIONS Treatment delay of several months or even years does not appear to affect outcomes of men with low-risk PCa. Limited data suggest treatment delay may have an impact on men with non-low-risk PCa. Most AS protocols suggest a confirmatory biopsy to avoid delaying treatment in those who harbour higher risk disease that was initially misclassified.
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Affiliation(s)
- Roderick C N van den Bergh
- University Medical Centre Utrecht, Utrecht, The Netherlands; Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Pathological, oncologic and functional outcomes of radical prostatectomy following active surveillance. J Urol 2013; 190:91-5. [PMID: 23321581 DOI: 10.1016/j.juro.2013.01.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/08/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE We examined prostatectomy pathology, and oncologic and functional outcomes of men progressing from active surveillance to radical prostatectomy. MATERIALS AND METHODS We identified patients on active surveillance treated with radical prostatectomy. We compared patients on active surveillance ultimately treated with radical prostatectomy to age and prostate specific antigen matched men undergoing immediate radical prostatectomy after a diagnosis of low risk disease who were candidates for active surveillance (group 1). We also compared patients on active surveillance with progression to Gleason 7 disease to men treated who had similar de novo disease (group 2) to determine whether patients on active surveillance have potentially adverse outcomes. RESULTS Of 289 patients on active surveillance 41 (14.2%) underwent radical prostatectomy after a median of 35.2 months (IQR 22.8-46.6) on active surveillance. Compared to group 1, the radical prostatectomy after active surveillance group had expectedly worse pathological outcomes, whereas the pathological outcomes of patients undergoing radical prostatectomy after active surveillance with progression to Gleason 7 disease were similar to those of group 2. At a median of 3.5 years from radical prostatectomy (IQR 2.6-4.7), biochemical recurrence was low and comparable between the radical prostatectomy after active surveillance group and group 1 (2.6% vs 5.4%, p = 0.47), while erectile function was 29.0% and continence 89.7%, comparable to both groups. CONCLUSIONS Radical prostatectomy after a period of active surveillance does not appear to result in adverse pathological outcomes compared to patients with a similar preoperative pathology.
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