Prostate CancerTreatment Outcomes of Radical Prostatectomy in Potential Candidates for 3 Published Active Surveillance Protocols
Section snippets
Material and Methods
Between 1983 and 2006, a total of 4265 men underwent open RRP by a single surgeon (W.J.C.). Patients who met the criteria for 3 published active monitoring protocols were identified: (1) clinically localized disease, biopsy Gleason score ≤7, and no significant co-morbidities (Patel et al)9; (2) clinical stage T1b-T2b N0M0 disease, biopsy Gleason score ≤7, and prostate-specific antigen ≤15 ng/mL (Choo et al)10; or (3) clinical stage T1c disease (Mohler et al).11
In men who met these criteria, but
Results
Of the 4265 original patients, 4060 (95%) had data available for analysis. A total of 3959, 3536, and 2330 men who would have met the Patel,9 Choo,10 and Mohler11 criteria for AS, respectively, were treated by immediate RRP. Table 1 shows the demographic information for patients meeting criteria for each of the 3 protocols. Most patients were white and had a biopsy Gleason score ≤6.
Table 2 shows the pathology tumor features and outcomes data for each subset of patients. Between 3% and 4% of
Comment
To limit the potential for “over-treating” low-risk prostate cancer, several active monitoring protocols have been reported for patients with favorable disease characteristics at the time of diagnosis. The ideal AS protocol would require: (1) an accurate preoperative tool to predict which individuals have truly indolent disease, (2) parameters that can be serially monitored to rapidly identify individuals with disease progression, and (3) the potential for delayed treatment with the same
Conclusions
AS protocols are offered to patients with low-risk prostate cancer. We retrospectively examined the pathology features and biochemical progression-free survival rates among men who would have met 3 active monitoring criteria from the published data but elected active treatment. Of these men, an appreciable proportion had aggressive features in the prostatectomy specimen and/or biochemical progression. Because of the limitations of current clinical staging, some men with apparent low-risk
Acknowledgment
C. Shad Thaxton acknowledges the Robert H. Lurie Comprehensive Cancer Center of Northwestern University for a Zell Family Faculty Award.
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Supported by the Urological Research Foundation, Beckman Coulter, Inc., the Prostate SPORE grant (P50 CA90386-05S2) and the Robert H. Lurie Comprehensive Cancer Center grant (P30 CA60553) (to (W.J.C.).