Evaluating the Safety of Active Surveillance: Outcomes of Deferred Radical Prostatectomy after an Initial Period of Surveillance

医学 前列腺切除术 主动监测 小心等待 泌尿科 重症监护医学 前列腺 前列腺癌 内科学 计算机科学 实时计算 癌症
作者
Ashwin Balakrishnan,Janet E. Cowan,Matthew R. Cooperberg,Katsuto Shinohara,Hao G. Nguyen,Peter R. Carroll
出处
期刊:The Journal of Urology [Lippincott Williams & Wilkins]
卷期号:202 (3): 506-510 被引量:25
标识
DOI:10.1097/ju.0000000000000247
摘要

As enrollment in active surveillance expands, it is increasingly important to assess the potential risks of deferred treatment. We evaluated the risk of prostate specific antigen recurrence in a large cohort of men who underwent radical prostatectomy after initial active surveillance.The study included men who underwent radical prostatectomy after a period of active surveillance. At diagnosis the men had GG (Gleason Grade Group) 1 or 2, clinical T2 or less and low or intermediate risk disease. They were stratified by a composite variable of GG and the volume of high grade cores at diagnosis. Pathological characteristics and recurrence after radical prostatectomy were evaluated.Of 1,916 men enrolled in active surveillance between 1994 and 2017, 448 (23.4%) underwent deferred radical prostatectomy. Median time to radical prostatectomy was 27 months (IQR 15.5-46.5). At diagnosis 388 men (86.6%) had GG1 disease, 31 (6.9%) had GG2 disease with 1 high grade core and 29 (6.5%) had GG2 disease with 2 or more high grade cores. GG2 with 2 or more high grade cores at diagnosis was associated with an increased risk of recurrence compared to GG1 disease (HR 3.29, 95% CI 1.49-7.26, p <0.01). GG2 disease with 1 high grade core did not significantly differ from GG1.Our results support the careful use of active surveillance in men with GG2 and 1 high grade core at diagnosis. Men with 2 or more high grade (GG2 or greater) cores at diagnosis may benefit from immediate treatment.
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