Comparison of Pathological Outcomes for Men with Low Risk Prostate Cancer from Diverse Practice Settings: Similar Results from Immediate Prostatectomy or Initial Surveillance with Delayed Prostatectomy

No AccessJournal of UrologyAdult Urology1 Nov 2016Comparison of Pathological Outcomes for Men with Low Risk Prostate Cancer from Diverse Practice Settings: Similar Results from Immediate Prostatectomy or Initial Surveillance with Delayed Prostatectomy Gregory B. Auffenberg, Susan Linsell, Apoorv Dhir, Stacie N. Myers, Bradley Rosenberg, David C. Miller, and Michigan Urological Surgery Improvement Collaborative Gregory B. AuffenbergGregory B. Auffenberg Department of Urology, University of Michigan, Ann Arbor, Michigan , Susan LinsellSusan Linsell Department of Urology, University of Michigan, Ann Arbor, Michigan , Apoorv DhirApoorv Dhir Department of Urology, University of Michigan, Ann Arbor, Michigan , Stacie N. MyersStacie N. Myers Department of Urology, University of Michigan, Ann Arbor, Michigan , Bradley RosenbergBradley Rosenberg Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan , David C. MillerDavid C. Miller Department of Urology, University of Michigan, Ann Arbor, Michigan , and Michigan Urological Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1016/j.juro.2016.05.095AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared pathological outcomes after radical prostatectomy for a population based sample of men with low risk prostate cancer initially on active surveillance and undergoing delayed prostatectomy vs those treated with immediate surgery in order to better understand this expectant management approach outside of the context of academic cohorts. We hypothesized that delays in surgery due to initial surveillance would not impact surgical pathological outcomes. Materials and Methods: We performed a prospective cohort study of 2 groups of patients with NCCN low risk prostate cancer from practices in the Michigan Urological Surgery Improvement Collaborative, that is 1) men who chose initial active surveillance and went on to delayed prostatectomy and 2) men who chose immediate prostatectomy. Diagnoses occurred from January 2011 through August 2015. For these 2 groups we compared radical prostatectomy Gleason scores, and rates of extraprostatic disease, positive surgical margins, seminal vesicle invasion and lymph node metastases. Results: During a median followup of 506 days 79 (6%) of 1,359 low risk men choosing initial surveillance transitioned to prostatectomy. Compared to those treated with immediate prostatectomy (778), men undergoing delayed surgery were more likely to have Gleason score 7 or greater disease (69.2% vs 48.8%, respectively, p=0.004), but were no more likely to have positive margins, extraprostatic extension, seminal vesicle invasion or lymph node metastases. Conclusions: Patients with low risk prostate cancer who enter active surveillance have higher grade disease at prostatectomy compared to those undergoing immediate surgery. However, the lack of difference in other adverse pathological outcomes suggests preservation of the window of curability. References 1 : Immediate versus delayed radical prostatectomy: updated outcomes following active surveillance of prostate cancer. Eur Urol2015; 68: 458. Google Scholar 2 : Active surveillance for low-risk prostate cancer. Curr Urol Rep2015; 16: 24. 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Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byShiff B, Breau R, Patel P, Mallick R, Tanguay S, So A, Lavallée L, Moore R, Rendon R, Kapoor A, Pouliot F, Finelli A, Bhindi B, Lattouf J, Basappa N, Wood L, Heng D, Bjarnason G and Drachenberg D (2020) Impact of Time to Surgery and Surgical Delay on Oncologic Outcomes for Renal Cell CarcinomaJournal of Urology, VOL. 205, NO. 1, (78-85), Online publication date: 1-Jan-2021.Ginsburg K, Curtis G, Timar R, George A and Cher M (2020) Delayed Radical Prostatectomy is Not Associated with Adverse Oncologic Outcomes: Implications for Men Experiencing Surgical Delay Due to the COVID-19 PandemicJournal of Urology, VOL. 204, NO. 4, (720-725), Online publication date: 1-Oct-2020.Godtman R, Schafferer M, Pihl C, Stranne J and Hugosson J (2018) Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active SurveillanceJournal of Urology, VOL. 200, NO. 4, (779-785), Online publication date: 1-Oct-2018.Taneja S (2017) Re: 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate CancerJournal of Urology, VOL. 197, NO. 4, (1076-1078), Online publication date: 1-Apr-2017.Smith J (2016) This Month in Adult UrologyJournal of Urology, VOL. 196, NO. 5, (1333-1334), Online publication date: 1-Nov-2016. Volume 196Issue 5November 2016Page: 1415-1421 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordstreatment outcomeprostateprostatic neoplasmsneoplasmswatchful waitingAcknowledgmentsThe clinical champions, urologists, administrators and data abstractors at each participating MUSIC practice contributed significantly (details for specific participating urologists and practices can be found at www.musicurology.com), as did members of the MUSIC Coordinating Center at the University of Michigan. In addition, support was provided by David Share, Tom Leyden, Rozanne Darland, Karlie Witbrodt and the Value Partnerships program at BCBSM.MetricsAuthor Information Gregory B. Auffenberg Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Susan Linsell Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Apoorv Dhir Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Stacie N. Myers Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Bradley Rosenberg Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan Financial interest and/or other relationship with Myriad Genetics. More articles by this author David C. Miller Department of Urology, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Blue Cross Blue Shield of Michigan. More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...