1
|
Hikita K, Honda M, Shimizu R, Teraoka S, Kimura Y, Yumioka T, Tsounapi P, Iwamoto H, Morizane S, Takenaka A. The influence of the long duration from biopsy to surgery on biochemical recurrence after robot-assisted radical prostatectomy in Japanese patients. Asian J Surg 2021; 45:2179-2184. [PMID: 34810115 DOI: 10.1016/j.asjsur.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 10/14/2021] [Accepted: 10/27/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE We evaluated the impact of the duration between the biopsy and surgery on the biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). METHODS We retrospectively evaluated 302 patients who underwent RARP in our institution from April 2010 to December 2017. Patients were categorized into 2 groups, an interval between biopsy and surgery of 180 days or less (Group A) and longer than 180 days (Group B). Factors retrospectively analyzed for the BCR for the interval between the biopsy and RARP included patient's characteristics, intraoperative and postoperative results. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the predictors of BCR. RESULTS The median follow-up was 42 months, with 24 patients developing BCR at a mean of 13.5 months after RARP. There was no difference in the rate of BCR in Group A and Group B. Multivariate analysis showed that BMI (<23.5 kg/m2, p = 0.034), worst GS of the biopsy (≥8, p = 0.007), and without lymph node dissection (p = 0.034) were significant predictors of BCR. Analysis of the interval from the biopsy showed that there was no significant difference between Group A and Group B, when tested according to the NCCN risk stratification (low risk: p = 0.871, intermediate risk: p = 0.205, high risk: p = 0.287). CONCLUSION The preoperative predictors of BCR included BMI (<23.5 kg/m2) and worst GS of the biopsy, and without lymph node dissection. A long duration from biopsy to RARP did not influence the probability of BCR, even in patients considered to be at a high risk.
Collapse
Affiliation(s)
- Katsuya Hikita
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan.
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Yuske Kimura
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Tetsuya Yumioka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Panagiota Tsounapi
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| |
Collapse
|
2
|
Sean Ong XR, Condon B, Bagguley D, Lawrentschuk N, Azad A, Murphy D. Safety first: evidence for delay of radical prostatectomy without use of androgen deprivation therapy during COVID-19. Future Oncol 2020; 16:1409-1411. [PMID: 32407145 PMCID: PMC7226924 DOI: 10.2217/fon-2020-0388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Xuan Rui Sean Ong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Benjamin Condon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Dominic Bagguley
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Arun Azad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Fossati N, Rossi MS, Cucchiara V, Gandaglia G, Dell'Oglio P, Moschini M, Suardi N, Dehò F, Montorsi F, Schiavina R, Mottrie A, Briganti A. Evaluating the effect of time from prostate cancer diagnosis to radical prostatectomy on cancer control: Can surgery be postponed safely? Urol Oncol 2016; 35:150.e9-150.e15. [PMID: 27986374 DOI: 10.1016/j.urolonc.2016.11.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To test the prognostic role of treatment delay in patients affected by prostate cancer (PCa). MATERIALS AND METHODS The study included 2,653 patients treated with radical prostatectomy (RP) at a single institution between 2006 and 2011. The evaluated outcomes were biochemical recurrence (BCR) and clinical recurrence (CR). Multivariable Cox regression analysis was used to test the association between time from diagnosis to RP and oncological outcomes. Nonparametric curve fitting methods were used to graphically explore the relationship between time from diagnosis to RP and oncological outcomes. Sensitivity analyses were repeated in the subgroups of low-, intermediate-, and high-risk patients. RESULTS At median follow-up of 56 months (interquartile range: 26, 92), 283 patients experienced BCR, and 84 patients developed CR. Median time from PCa diagnosis to surgery was 2.8 months (interquartile range: 1.6, 4.7). At multivariable Cox regression analysis, time from biopsy to RP was significantly associated with an increased risk of BCR (hazard ratio = 1.02, P = 0.0005) and CR (hazard ratio = 1.03, P = 0.0002). Using Nonparametric curve fitting methods, a significant increased risk of BCR and CR after approximately 18 months was observed. However, when sensitivity analyses were repeated according to risk groups, this effect was maintained in high-risk patients only, and such time interval was reduced to 12 months. CONCLUSIONS Despite the overall trend on higher rate of cancer relapse after RP, the effect of treatment delay from biopsy to RP was significantly evident in high-risk patients only. Even in high-risk patients surgical treatment can be postponed safely, but not beyond the 12-month landmark.
Collapse
Affiliation(s)
- Nicola Fossati
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; OLV Ziekenhuis, Department of Urology, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Martina Sofia Rossi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vito Cucchiara
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Dell'Oglio
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Moschini
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alexandre Mottrie
- OLV Ziekenhuis, Department of Urology, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Michael R Abern
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27705, USA.
| | | | | | | | | | | | | |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
- Roderick C N van den Bergh
- University Medical Centre Utrecht, Utrecht, The Netherlands; Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
7
|
[Complications and nerve preservation in prostatectomy according to the time interval from diagnostic biopsy]. Actas Urol Esp 2012; 36:178-85. [PMID: 21742416 DOI: 10.1016/j.acuro.2011.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks). MATERIAL AND METHODS Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently. RESULTS For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations. CONCLUSIONS The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications.
Collapse
|
8
|
Kim IS, Na W, Nam JS, Oh JJ, Jeong CW, Hong SK, Byun SS, Lee SE. Interval from Prostate Biopsy to Robot-Assisted Laparoscopic Radical Prostatectomy (RALP): Effects on Surgical Difficulties. Korean J Urol 2011; 52:664-8. [PMID: 22087359 PMCID: PMC3212659 DOI: 10.4111/kju.2011.52.10.664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 08/11/2011] [Indexed: 11/29/2022] Open
Abstract
Purpose Traditionally, an interval of 4 to 6 weeks has been recommended after prostate biopsy before open radical prostatectomy. However, such an interval is not explicitly specified in robot-assisted laparoscopic radical prostatectomy (RALP). This study was designed to determine whether the interval from prostate biopsy to RALP affects surgical difficulties. Materials and Methods Between January 2008 and May 2009, a total of 237 men underwent
RALP in our institution. The interval from biopsy to RALP was categorized as follows: ≤ 2 weeks, >2 to ≤ 4 weeks, >4 to ≤ 6 weeks, >6 to ≤ 8 weeks, and >8 weeks. Multivariate analysis was used to identify whether the interval from prostate biopsy to RALP was an independent predictor of operative time, estimated blood loss (EBL), margin positivity, continence, and potency. Results Among the 5 groups, there were no significant differences in age, body mass index (BMI), preoperative serum prostate-specific antigen (PSA), prostate volume, or preoperative International Index of Erectile Dysfunction-5 score (all p>0.05). In the multivariate analysis, operative time was significantly associated with prostate volume. EBL was associated with prostate volume and BMI. Margin positivity was associated with preoperative serum PSA, prostate volume, and biopsy Gleason score. Postoperative continence and potency were significantly associated with age. However, in univariate and multivariate analyses, the interval from biopsy to RALP was not significantly associated with operative time, EBL, margin positivity, postoperative continence, or potency (all p>0.05). Conclusions Our data suggest that the interval from prostate biopsy to RALP is not related to surgical difficulties.
Collapse
Affiliation(s)
- In Sung Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Martin GL, Nunez RN, Humphreys MD, Martin AD, Ferrigni RG, Andrews PE, Castle EP. Interval from prostate biopsy to robot-assisted radical prostatectomy: effects on perioperative outcomes. BJU Int 2009; 104:1734-7. [DOI: 10.1111/j.1464-410x.2009.08685.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Alonso AR, Blanco AG, Fernández SP, Díaz SP, Martín CB, Cuerpo Pérez MA. Influencia de la demora quirúrgica en los hallazgos patológicos y el pronóstico de los pacientes con cáncer de próstata. Actas Urol Esp 2009. [DOI: 10.1016/s0210-4806(09)73183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
[Early biochemical failure after radical prostatectomy for prostate cancer. Impact factors?]. Actas Urol Esp 2008; 32:406-10. [PMID: 18540261 DOI: 10.1016/s0210-4806(08)73854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Does delay from biopsy to surgery have any influence? OBJECTIVES To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. MATERIAL AND METHODS We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group's EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. RESULTS There are no differences between the two groups in age (p<0.129), PSA (p<0.479), biopsy's Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy's Gleason nor specimen's Gleason, nor WT, impact on the EBF. CONCLUSIONS Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis.
Collapse
|
12
|
Nepple KG, Joudi FN, Hillis SL, Wahls TL. Prevalence of delayed clinician response to elevated prostate-specific antigen values. Mayo Clin Proc 2008; 83:439-45. [PMID: 18380989 DOI: 10.4065/83.4.439] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the frequency of delayed response to an abnormal prostate-specific antigen (PSA) value. PATIENTS AND METHODS Retrospective review of prostate cancer cases diagnosed between January 1, 2000, and December 31, 2005, in a rural Department of Veterans Affairs health care system serving 44,000 veterans across 2 states. Clinician response was defined as a reference to the elevated PSA result in clinical notes, orders for further evaluation, treatment of presumed prostatitis, or a urology visit or referral. Delay was measured as days between an abnormal PSA result and clinician response. RESULTS We identified 327 men who met inclusion criteria with an abnormal PSA value before prostate cancer diagnosis. At first PSA elevation, median age was 64 years; 94% were younger than 75 years. Of the 327 men, 253 (77.4%) had a timely (< or =30 days) response to an abnormal PSA value; 23 (7.0%) had between 31 and 180 days; 24 (7.3%), between 181 and 360 days; and 27 (8.3%), more than 360 days between an abnormal PSA measurement and clinician response. The delayed group had nearly an additional year's (309 days) lapse before completed urologic consultation and prostate gland biopsy (313 days) as compared with the timely group. The presence of urologic symptoms, abnormal results from rectal examination, higher PSA values, and higher PSA velocity (P<.05) were associated with timely clinician response to an abnormal PSA measurement. CONCLUSION In a cohort of men with prostate cancer and an antecedent abnormal PSA value, 15.6% had more than 180 days between an abnormal PSA measurement and clinician response. These findings add to the growing literature demonstrating that missed results occur more frequently than is generally appreciated. Improved systems for clinical data management are needed.
Collapse
|
13
|
Freedland SJ, Kane CJ, Amling CL, Aronson WJ, Presti JC, Terris MK. Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer. J Urol 2006; 175:1298-302; discussion 1302-3. [PMID: 16515984 DOI: 10.1016/s0022-5347(05)00646-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Men newly diagnosed with prostate cancer are faced with multiple treatment options. Understanding these options and their associated side effects, and making a decision often requires time, resulting in a delay before receiving treatment. This is particularly pertinent in men with low risk disease who may be considered candidates for watchful waiting and, thus, may not experience strong pressure to undergo treatment promptly. Whether delays and especially prolonged delays, eg greater than 180 days, before RP negatively impact the disease outcome is unclear. MATERIALS AND METHODS We examined the association between time from diagnosis to surgery, and pathological features of the RP specimen and risk of biochemical progression in 895 men with low risk prostate cancer (prostate specific antigen less than 10 ng/ml and biopsy Gleason sum 6 or less) treated with RP between 1988 and 2004 in the Shared-Equal Access Regional Cancer Hospital Database using logistic regression and Cox proportional hazards, respectively. RESULTS Time from biopsy to surgery was not significantly related to high grade disease in the RP specimen, positive surgical margins or extraprostatic extension (all p-trend >0.05). After adjustment for multiple clinical covariates a longer time from biopsy to surgery was significantly associated with an increased risk of biochemical progression (p-trend = 0.002). However, this increased risk of progression was only apparent in men with delays greater than 180 days (median 263, vs 90 or fewer days RR 2.73, 95% CI 1.51 to 4.94). CONCLUSIONS Our data suggest that patients with low risk prostate cancer can be reassured that immediate treatment is not necessary. Whether long delays (greater than 180 days) decrease the likelihood of curability in some patients requires further study.
Collapse
Affiliation(s)
- Stephen J Freedland
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | | | |
Collapse
|