Oncologic Outcomes Following Radical Prostatectomy in the Active Surveillance Era
CUA Online Library. Louis A. 06/25/13; 31350; MP-08.20
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Abstract
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Introduction and objectives: To examine the oncologic outcomes of men with low, intermediate and high pre-operative risk prostate cancer treated with radical prostatectomy prior to and during the active surveillance era.
Methods: We analyzed records from patients who underwent radical prostatectomy at the Princess Margaret Cancer Centre from 2000-2012. Patients were stratified by D’Amico pre-operative risk category and by year of treatment. Biochemical recurrence-free survival was estimated using the Kaplan Meier method.
Results: We included 2643 consecutive patients in our analysis. The proportion of men with low risk disease undergoing radical prostatectomy decreased from 2007 onwards coincident with the implementation of an active surveillance strategy in our institution. The 3-year recurrence free estimates of the low risk group before and after 2007 were 89.6% compared to 80.3% (p<0.05), those of the intermediate risk group were 74.1% compared to 70.6% (p=0.27) and the high risk group estimates were 43.8% compared to 33.5% (p=0.049). Within the low risk cohort, the later treatment group displayed significantly lower age, pre-treatment prostate specific antigen and tumour volume and significantly higher testosterone and body mass index.
Conclusions: The time period corresponding with the implementation of active surveillance at our institution corresponded with significant deterioration of biochemical outcomes in the low and high risk groups. This suggests that the men with most favourable disease deferred treatment, whereas men with worse pre-operative disease characteristics were increasingly treated with radical prostatectomy in the past six years perhaps to their benefit.
Methods: We analyzed records from patients who underwent radical prostatectomy at the Princess Margaret Cancer Centre from 2000-2012. Patients were stratified by D’Amico pre-operative risk category and by year of treatment. Biochemical recurrence-free survival was estimated using the Kaplan Meier method.
Results: We included 2643 consecutive patients in our analysis. The proportion of men with low risk disease undergoing radical prostatectomy decreased from 2007 onwards coincident with the implementation of an active surveillance strategy in our institution. The 3-year recurrence free estimates of the low risk group before and after 2007 were 89.6% compared to 80.3% (p<0.05), those of the intermediate risk group were 74.1% compared to 70.6% (p=0.27) and the high risk group estimates were 43.8% compared to 33.5% (p=0.049). Within the low risk cohort, the later treatment group displayed significantly lower age, pre-treatment prostate specific antigen and tumour volume and significantly higher testosterone and body mass index.
Conclusions: The time period corresponding with the implementation of active surveillance at our institution corresponded with significant deterioration of biochemical outcomes in the low and high risk groups. This suggests that the men with most favourable disease deferred treatment, whereas men with worse pre-operative disease characteristics were increasingly treated with radical prostatectomy in the past six years perhaps to their benefit.
Introduction and objectives: To examine the oncologic outcomes of men with low, intermediate and high pre-operative risk prostate cancer treated with radical prostatectomy prior to and during the active surveillance era.
Methods: We analyzed records from patients who underwent radical prostatectomy at the Princess Margaret Cancer Centre from 2000-2012. Patients were stratified by D’Amico pre-operative risk category and by year of treatment. Biochemical recurrence-free survival was estimated using the Kaplan Meier method.
Results: We included 2643 consecutive patients in our analysis. The proportion of men with low risk disease undergoing radical prostatectomy decreased from 2007 onwards coincident with the implementation of an active surveillance strategy in our institution. The 3-year recurrence free estimates of the low risk group before and after 2007 were 89.6% compared to 80.3% (p<0.05), those of the intermediate risk group were 74.1% compared to 70.6% (p=0.27) and the high risk group estimates were 43.8% compared to 33.5% (p=0.049). Within the low risk cohort, the later treatment group displayed significantly lower age, pre-treatment prostate specific antigen and tumour volume and significantly higher testosterone and body mass index.
Conclusions: The time period corresponding with the implementation of active surveillance at our institution corresponded with significant deterioration of biochemical outcomes in the low and high risk groups. This suggests that the men with most favourable disease deferred treatment, whereas men with worse pre-operative disease characteristics were increasingly treated with radical prostatectomy in the past six years perhaps to their benefit.
Methods: We analyzed records from patients who underwent radical prostatectomy at the Princess Margaret Cancer Centre from 2000-2012. Patients were stratified by D’Amico pre-operative risk category and by year of treatment. Biochemical recurrence-free survival was estimated using the Kaplan Meier method.
Results: We included 2643 consecutive patients in our analysis. The proportion of men with low risk disease undergoing radical prostatectomy decreased from 2007 onwards coincident with the implementation of an active surveillance strategy in our institution. The 3-year recurrence free estimates of the low risk group before and after 2007 were 89.6% compared to 80.3% (p<0.05), those of the intermediate risk group were 74.1% compared to 70.6% (p=0.27) and the high risk group estimates were 43.8% compared to 33.5% (p=0.049). Within the low risk cohort, the later treatment group displayed significantly lower age, pre-treatment prostate specific antigen and tumour volume and significantly higher testosterone and body mass index.
Conclusions: The time period corresponding with the implementation of active surveillance at our institution corresponded with significant deterioration of biochemical outcomes in the low and high risk groups. This suggests that the men with most favourable disease deferred treatment, whereas men with worse pre-operative disease characteristics were increasingly treated with radical prostatectomy in the past six years perhaps to their benefit.
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