Oncologic outcomes following radical prostatectomy in the active surveillance era

Authors

  • Alyssa S. Louis
  • Robin Kalnin
  • Manjula Maganti Department of Biostatistics, University Health Network, Toronto, Canada
  • Melania Pintilie Department of Biostatistics, University Health Network, Toronto, Canada
  • Andrew G Matthew Department of Psychosocial Oncology and Palliative Care, University Health Network, Toronto, Canada
  • Antonio Finelli Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Alexandre R Zlotta R Zlotta Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Neil Fleshner Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Girish Kulkarni Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Robert Hamilton Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Michael Jewett Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Michael Robinette Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada
  • Shabbir MH Alibhaid Department of Medicine , University Health Network, Toronto, Canada
  • John Trachtenberg Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Canada

DOI:

https://doi.org/10.5489/cuaj.1404

Abstract

Objective: In this study, we examine the oncologic outcomes of men with low, intermediate and high preoperative risk for 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 our Canadian tertiary care facility from 2000 to 2012. Patients were stratified by D’Amico preoperative 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. Men with low-risk and high-risk disease showed significantly worse biochemical outcomes from 2007 to 2012 compared to 2000 to 2006 (p < 0.05), while men with intermediate-risk prostate cancer showed no significant differences (p = 0.27). 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 preoperative disease characteristics were increasingly treated with radical prostatectomy in the past 6 years perhaps to their benefit.

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Published

2013-07-02

How to Cite

Louis, A. S., Kalnin, R., Maganti, M., Pintilie, M., Matthew, A. G., Finelli, A., Zlotta, A. R. Z. R., Fleshner, N., Kulkarni, G., Hamilton, R., Jewett, M., Robinette, M., Alibhaid, S. M., & Trachtenberg, J. (2013). Oncologic outcomes following radical prostatectomy in the active surveillance era. Canadian Urological Association Journal, 7(7-8), E475–80. https://doi.org/10.5489/cuaj.1404

Issue

Vol. 7 No. 7-8 (2013): CUAJ July

Section

Original Research

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