Long-term and pathological outcomes of low- and intermediate-risk prostate cancer after radical prostatectomy: implications for active surveillance
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| Název: | Long-term and pathological outcomes of low- and intermediate-risk prostate cancer after radical prostatectomy: implications for active surveillance |
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| Autoři: | Valentin H. Meissner, Mira Woll, Donna P. Ankerst, Stefan Schiele, Jürgen E. Gschwend, Kathleen Herkommer |
| Zdroj: | World J Urol |
| Informace o vydavateli: | Springer Science and Business Media LLC, 2021. |
| Rok vydání: | 2021 |
| Témata: | Male, Prostatectomy, 2. Zero hunger, ddc:610, Clinical Decision-Making [MeSH], Watchful Waiting [MeSH], Aged [MeSH], Risk Assessment [MeSH], Prostatic Neoplasms/mortality [MeSH], Kaplan-Meier Estimate [MeSH], Humans [MeSH], Active surveillance, Prostatic Neoplasms/pathology [MeSH], Middle Aged [MeSH], Radical prostatectomy, Original Article, Chemotherapy, Adjuvant [MeSH], Proportional Hazards Models [MeSH], Male [MeSH], Disease-Free Survival [MeSH], Prostatic Neoplasms/therapy [MeSH], Antineoplastic Agents, Hormonal/therapeutic use [MeSH], Favorable intermediate risk, Prostatectomy [MeSH], Radiotherapy, Adjuvant [MeSH], Oncological outcome, Prostate cancer, Antineoplastic Agents, Hormonal, Clinical Decision-Making, Prostatic Neoplasms, Kaplan-Meier Estimate, Middle Aged, Risk Assessment, Disease-Free Survival, ddc, 3. Good health, Chemotherapy, Adjuvant, Humans, Radiotherapy, Adjuvant, Watchful Waiting, Aged, Proportional Hazards Models |
| Popis: | Purpose The safety of active surveillance (AS) in favorable intermediate-risk (FIR) prostate cancer (PCa) remains uncertain. To provide guidance on clinical decision-making, we examined long-term and pathological outcomes of low-risk and intermediate-risk PCa patients after radical prostatectomy (RP). Methods The study involved 5693 patients diagnosed between 1994 and 2019 with low-risk, FIR, and unfavorable intermediate-risk (UIR) PCa (stratification according to the AUA guidelines) who underwent RP. Pathological outcomes were compared, and Kaplan–Meier analysis determined biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) at 5, 10, 15, and 20 years. Multiple Cox regression was used to simultaneously control for relevant confounders. Results Those at FIR had higher rates of upgrading and upstaging (12.8% vs. 7.2%, p p p p > 0.001) compared to patients at low risk. The 20-year BRFS was 69%, 65%, and 44% and the 20-year CSS was 98%, 95%, and 89% in low-risk, FIR, and UIR patients. On multiple Cox regression, FIR was not associated with a worse BRFS (HR 1.07, CI 0.87–1.32), UIR was associated with a worse BRFS (HR 1.49, CI 1.20–1.85). Conclusion Patients at FIR had only slightly worse pathological and long-term outcomes compared to patients at low risk, whereas the difference compared to patients at UIR was large. This emphasizes AS in these patients as a possible treatment strategy in well-counseled patients. |
| Druh dokumentu: | Article Other literature type |
| Popis souboru: | application/pdf |
| Jazyk: | English |
| ISSN: | 1433-8726 0724-4983 |
| DOI: | 10.1007/s00345-021-03717-2 |
| Přístupová URL adresa: | https://link.springer.com/content/pdf/10.1007/s00345-021-03717-2.pdf https://pubmed.ncbi.nlm.nih.gov/33973043 https://link.springer.com/content/pdf/10.1007/s00345-021-03717-2.pdf https://link.springer.com/article/10.1007/s00345-021-03717-2 https://www.ncbi.nlm.nih.gov/pubmed/33973043 https://europepmc.org/article/MED/33973043 https://pubmed.ncbi.nlm.nih.gov/33973043/ http://www.ncbi.nlm.nih.gov/pubmed/33973043 https://nbn-resolving.org/urn:nbn:de:bvb:384-opus4-920802 https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/92080 https://doi.org/10.1007/s00345-021-03717-2 https://opus.bibliothek.uni-augsburg.de/opus4/files/92080/Meissner2021_Long-termAndPathologicalOutcom.pdf https://repository.publisso.de/resource/frl:6447733 https://mediatum.ub.tum.de/doc/1638242/document.pdf |
| Rights: | CC BY URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) . |
| Přístupové číslo: | edsair.doi.dedup.....bf8c1c4252b03d2b1cc6a94957bc64a6 |
| Databáze: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Purpose The safety of active surveillance (AS) in favorable intermediate-risk (FIR) prostate cancer (PCa) remains uncertain. To provide guidance on clinical decision-making, we examined long-term and pathological outcomes of low-risk and intermediate-risk PCa patients after radical prostatectomy (RP). Methods The study involved 5693 patients diagnosed between 1994 and 2019 with low-risk, FIR, and unfavorable intermediate-risk (UIR) PCa (stratification according to the AUA guidelines) who underwent RP. Pathological outcomes were compared, and Kaplan–Meier analysis determined biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) at 5, 10, 15, and 20 years. Multiple Cox regression was used to simultaneously control for relevant confounders. Results Those at FIR had higher rates of upgrading and upstaging (12.8% vs. 7.2%, p p p p > 0.001) compared to patients at low risk. The 20-year BRFS was 69%, 65%, and 44% and the 20-year CSS was 98%, 95%, and 89% in low-risk, FIR, and UIR patients. On multiple Cox regression, FIR was not associated with a worse BRFS (HR 1.07, CI 0.87–1.32), UIR was associated with a worse BRFS (HR 1.49, CI 1.20–1.85). Conclusion Patients at FIR had only slightly worse pathological and long-term outcomes compared to patients at low risk, whereas the difference compared to patients at UIR was large. This emphasizes AS in these patients as a possible treatment strategy in well-counseled patients. |
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| ISSN: | 14338726 07244983 |
| DOI: | 10.1007/s00345-021-03717-2 |