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You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2012

997 DELAYED RADICAL PROSTATECTOMY IN GLEASON 7 PROSTATE CANCER DECREASES TIME TO BIOCHEMICAL RECURRENCE: RESULTS FROM THE SEARCH DATABASE

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    INTRODUCTION AND OBJECTIVES

    As concerns mount regarding overtreatment and over-diagnosis of prostate cancer (PC), active surveillance (AS) is increasingly accepted as appropriate management for low-risk patients (i.e. men with Gleason 6 disease). While it appears safe to delay treatment in low-risk men, it is unknown whether this is safe for men with higher risk PC including those with Gleason sum (GS) 7 or higher. The aim of this study was to investigate whether delaying radical prostatectomy (RP) affected biochemical recurrence (BCR) as a function of biopsy grade.

    METHODS

    We performed a retrospective analysis of 2,195 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated for PC with RP with complete data. The interval between diagnostic biopsy and RP was stratified to < 3 months, 3 to 6 months, 6 to 9 months, or > 9 months (few men had delays >12 months). Patients were stratified by biopsy GS: <6, 7, or >8. Cox proportional hazard models were used to analyze time to BCR by time to RP stratified by GS. Models were adjusted for age, race, year of surgery, surgical center, pre-operative PSA, number of biopsy cores with cancer, and clinical stage.

    RESULTS

    In this cohort, 1,324 (60%) men had biopsy GS <6, 665 (30%) had biopsy GS=7, and 206 (9%) had biopsy GS >8. The median follow-up among men who did not recur was 51 months, during which 721 men (32%) experienced BCR. For men with GS <6, no time interval from biopsy to RP was significantly related to BCR (all p>0.05). However, delays >9 months were significantly related to BCR for men with GS 7 (HR 2.41, p = 0.005) and GS >8 (HR 31.62, p = 0.001), while delays of 3-6 and 6-9 months were not. Even for men with low volume GS 7 (<2 positive cores), delays >9 were associated with BCR (HR 3.51, p=0.034).

    CONCLUSIONS

    For low-risk men, we found no effect of delays of RP, as has been previously demonstrated. For men with GS 7, even low-volume GS 7, delays >9 months predicted greater risk of BCR. If confirmed in future studies, these findings may have implications for whether men with Gleason 7 should be included in AS protocols.

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