Active Surveillance & Delayed Prostatectomy

[pjoshea13]

New study below.

Active surveillance [AS] has been heavily promoted, but eligible men continue to opt for treatment in large numbers. AS would be more attractive if there was no downside, but between a quarter & a third of men will progress while on AS. Common sense would suggest that a cure might be less likely after a significant delay.

"Between 2000 and 2014, 961 patients were AS eligible as per EAU criteria. RP within 6 months of diagnosis (IRP) or beyond (DRP), RP without AS (DRPa) and AS patients progressing to RP (DRPb) were compared."

{Jump to the CONCLUSIONS, below, if you want to skip the detail.}

"IRP, DRP, DRPa and DRPb had 820 (85%), 141 (15%), 118 (12.24%) and 23 (2.7%) patients respectively."

"IRP, DRPa and DRPb underwent RP at a median of 3, 9 and 19 months after diagnosis respectively".

"Baseline characteristics were comparable."

"DRP vs. IRP had earlier median time (31 vs. 43 months ...) and higher rate of progression to BCR (7.6 vs. 3.9% ...)."

"DRPb showed higher BCR (19 vs. 5% ...) with earlier median time to BCR, compared to IRP and DRPa ..."

"There was no difference in adverse pathology and BCR rates, but time to BCR was significantly lesser in DRPb (49 vs. 6 months ...), compared to GS7IRP."

"CONCLUSIONS: Patients progressing on AS had worst oncological outcomes."

"Worse oncological outcomes in AS progressors cannot be explained by a mere delay in RP." (!!!)

-Patrick

ncbi.nlm.nih.gov/pubmed/309...

Actas Urol Esp. 2019 Mar 27. pii: S0210-4806(18)30124-4. doi: 10.1016/j.acuro.2018.04.005. [Epub ahead of print]

Immediate versus delayed prostatectomy and the fate of patients who progress to a higher risk disease on active surveillance.

[Article in English, Spanish]

Mallya A1, Senguttuvan-Karthikeyan V2, Sivaraman A3, Barret E3, Galiano M3, Cathala N3, Mombet A3, Prapotnich D3, Sanchez-Salas R4, Cathelineau X3.

Author information

1

Department of Urology, Fortis Escorts Kidney and Urology Institute, New Delhi, India.

2

Department of Urology, Sri Narayani Hospital and Research Centre, Vellore, India.

3

Department of Urology, Institut Montsouris, Université Paris-Descartes, París, Francia.

4

Department of Urology, Institut Montsouris, Université Paris-Descartes, París, Francia. Electronic address: [e-mail].

Abstract

INTRODUCTION:

Oncological outcomes of radical prostatectomy (RP) in patients progressing on active surveillance (AS) are debated. We compared outcomes of AS eligible patients undergoing RP immediately after diagnosis with those doing so after delay or disease progression on AS.

METHODS:

Between 2000 and 2014, 961 patients were AS eligible as per EAU criteria. RP within 6 months of diagnosis (IRP) or beyond (DRP), RP without AS (DRPa) and AS patients progressing to RP (DRPb) were compared. Baseline PSA, clinical and biopsy characteristics were noted. Oncological outcomes included adverse pathology in RP specimen and biochemical recurrence (BCR). Matched pair analysis was done between DRPb and GS7 patients undergoing immediate RP (GS7IRP).

RESULTS:

IRP, DRP, DRPa and DRPb had 820 (85%), 141 (15%), 118 (12.24%) and 23 (2.7%) patients respectively. IRP, DRPa and DRPb underwent RP at a median of 3, 9 and 19 months after diagnosis respectively. Baseline characteristics were comparable. DRP vs. IRP had earlier median time (31 vs. 43 months; p<.001) and higher rate of progression to BCR (7.6 vs. 3.9%;p=.045). DRPb showed higher BCR (19 vs. 5%;p=.021) with earlier median time to BCR, compared to IRP and DRPa (p=.038). There was no difference in adverse pathology and BCR rates, but time to BCR was significantly lesser in DRPb (49 vs. 6 months;p<.001), compared to GS7IRP.

CONCLUSIONS:

Patients progressing on AS had worst oncological outcomes. RP for GS7 progression and matched pair of GS7 patients had similar outcomes. Worse oncological outcomes in AS progressors cannot be explained by a mere delay in RP.

Copyright © 2018. Publicado por Elsevier España, S.L.U.

KEYWORDS:

Active surveillance; Cáncer de próstata; Delayed prostatectomy; Immediate prostatectomy; Progresión; Progression; Prostate cancer; Prostatectomía radical inmediata; Prostatectomía radical tardía; Vigilancia activa

PMID: 30928176 DOI: 10.1016/j.acuro.2018.04.005