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Delayed Surgery In Well-Selected Prostate Cancer Patients Not Associated With Worse Outcome

June 09, 2017

UroToday - There are two groups of patients with prostate cancer who opt for watchful waiting: those who will never receive definitive therapy (radiation or surgery) because of advanced age or co morbidities, and those who may choose to be treated at a later date if their "tumor progresses". One of the criticisms of delayed therapy or "active surveillance" is that the window of curability may be lost. Conversely, treating all patients early may invariable lead to over-treatment in some patients with insignificant tumors.

In the March issue of JNCI, Warlick, Carter and colleagues from Johns Hopkins present data from 38 patients with small, low grade tumors who enrolled in a watchful waiting program and later underwent radical prostatectomy at a median of 26 months. The pathologic stage of these patients was compared to a cohort of 150 patients who underwent surgery shortly (median 3 months) after diagnosis.

Adverse pathology was defined as those patients with less than a 75% probability of having disease recurrence after 10 years. These features were identified in 9 (23%) of the 38 patients in the delayed intervention cohort and in 24 (16%) of the 150 men in the immediate intervention group. In multivariate analysis adjusting for age and PSA density. There were no differences in the risk of adverse pathology (i.e. "noncurable cancer") between patients in the surveillance arm and those in the early treatment arm.

The authors conclude that delaying prostate cancer surgery in select patients with low volume, low grade tumors does not appear to compromise curability. This study is limited because of its small size, retrospective nature, and the fact patients were not matched priori for PSA and Gleason score.

By Ricardo Sánchez-Ortiz, MD

J Natl Cancer Inst. 2006 Mar 1; 98(5):355-7
Link Here.
Warlick C, Trock BJ, Landis P, Epstein JI, Carter HB

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