Outcomes After Radical Prostatectomy Among Men Who Are Candidates for Active Surveillance: Results From the SEARCH Database

被引:67
作者
Kane, Christopher J.
Im, Ronald
Amling, Christopher L.
Presti, Joseph C., Jr.
Aronson, William J.
Terris, Martha K.
Freedland, Stephen J.
机构
[1] Univ Calif San Diego, Div Urol, Dept Surg, San Diego, CA 92103 USA
[2] Moores UCSD Canc Ctr, La Jolla, CA USA
[3] Vet Affairs San Diego Med Ctr, Urol Sect, San Diego, CA USA
[4] Univ Alabama, Dept Urol, Birmingham, AL USA
[5] Stanford Univ, Sch Med, Dept Urol, Palo Alto, CA 94304 USA
[6] Vet Affairs Palo Alto Hlth Care Syst, Urol Sect, Palo Alto, CA USA
[7] Vet Affairs Greater Los Angeles Healthcare Syst, Urol Sect, Los Angeles, CA USA
[8] Univ Calif Los Angeles, Sch Med, Dept Urol, Los Angeles, CA USA
[9] Charlie Norwood Vet Affairs Med Ctr, Urol Sect, Augusta, GA USA
[10] Med Coll Georgia, Urol Sect, Augusta, GA 30912 USA
[11] Vet Affairs Med Ctr, Urol Sect, Durham, NC USA
[12] Duke Univ, Sch Med, Dept Surg, Div Urol Surg, Durham, NC USA
[13] Duke Univ, Sch Med, Dept Pathol, Durham, NC 27706 USA
[14] Duke Univ, Sch Med, Duke Prostate Ctr, Durham, NC 27706 USA
基金
美国国家卫生研究院;
关键词
AGENT-ORANGE; CANCER; RISK; BIOPSY; PREDICTOR; RECURRENCE; MANAGEMENT; CARCINOMA; VETERANS; EXPOSURE;
D O I
10.1016/j.urology.2009.12.073
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
100201 [内科学]; 100221 [泌尿外科学];
摘要
OBJECTIVE We sought to evaluate outcomes after radical prostatectomy among men with low-risk prostate cancer who would be candidates for active surveillance. METHODS Using the Shared Equal Access Regional Cancer Hospital (SEARCH) database of men treated with radical prostatectomy at multiple equal-access medical centers between 1988 and 2007, 398 of 2062 men (19%) met our criteria for potential active surveillance: clinical stage T1c or T2a, prostate-specific antigen (PSA) < 10 ng/mL, Gleason sum <= 6, and no more than 1 or 2 positive cores on at least a sextant biopsy. We examined the risk of adverse pathology, biochemical progression, and PSA doubling time (PSADT) at the time of recurrence. We used a Cox proportional hazards model to determine the significant predictors of PSA progression. RESULTS Of the men with low-risk prostate cancer, 85% had organ-confined disease, only 2% had seminal vesicle invasion, and no patient had lymph node metastasis. The 5- and 10 year PSA-free survival rates were 81% (95% CI: 76-86%) and 66% (95% CI: 54-76%). On multivariate analysis, older age (P = .005), Agent Orange exposure (P = .02), and obesity (P = .03) were all significantly associated with biochemical failure. Mean and median PSADT among men who experienced recurrence were 37 and 20 months. Only 3 patients experienced recurrence with PSADT < 9 months. CONCLUSIONS Most men with low-risk prostate cancer treated with radical prostatectomy experience long-term PSA control. Those who did experience recurrence often did so with a long PSADT. Consistent with prior SEARCH database reports, older age, Agent Orange exposure, and obesity increased the risk of recurrence. UROLOGY 76: 695-702, 2010. (C) 2010 Elsevier Inc. All rights reserved.
引用
收藏
页码:695 / 700
页数:6
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