Delaying surgery does not appear to harm men on active surveillance (AS) for prostate cancer (PCa), a new study finds.
Peter R. Carroll, MD, and colleagues of the University of California, San Francisco cancer center compared outcomes for 521 patients who underwent radical prostatectomy (RP) within 6 months of diagnosis and 157 patients who had delayed RP after a period (6–148 months) on AS.
PCa was upgraded to Gleason Score (GS) 3+4 in 54 men on AS during follow-up biopsy, according to findings published in European Urology. Men who had immediate RP were 66% less likely to have adverse pathology (e.g., Gleason upgrade, extraprostatic extension, seminal vesicle invasion, positive lymph nodes, or positive surgical margins) than men who had delayed RP.
To minimize the influence of selection bias, the investigators separately examined a subset of 216 men with GS 3+4 from both groups matched by pre-treatment biopsy features, including clinical stage, PSA, age, and year of diagnosis. In this instance, the rate of adverse pathology did not differ: 46% of the delayed RP group had at least 1 adverse feature compared with 44% of the immediate RP group.
“The presence of adverse pathologic features after surgery did not differ between men initially diagnosed with GS 3+4 disease and treated and men reclassified to GS 3+4 on follow-up biopsy after a period of AS and then treated,” the investigators explained. “This suggests that a window for cure was probably not missed during the time it took to identify the presence of higher-risk disease.” Over 3 years after RP, the 2 groups showed no difference in the rate of biochemical recurrence.
The study was observational, so additional research is warranted to corroborate the findings.
- Filippou, P; Welty, CJ; Cowan, JE; Perez, N; Shinohara, K; and Carroll, PR. European Urology; doi: doi: 10.1016/j.eururo.2015.06.011.