Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
J Urol. 2011 Jun;185(6):2143-7. doi: 10.1016/j.juro.2011.02.009. Epub 2011 Apr 15.
Treatment options for patients with low risk prostate cancer include radical prostatectomy, radiation therapy, and active surveillance. Among patients treated with radical prostatectomy, prior studies have demonstrated significantly higher biochemical progression rates with surgical delays of 6 months or greater. We determined the impact of surgical delay on radical prostatectomy outcomes specifically in low risk patients.
From our radical prostatectomy database we identified men who fulfilled the D'Amico low risk criteria (clinical stage T1c/T2a, prostate specific antigen less than 10 ng/ml, and biopsy Gleason 6 or less). Pathological tumor features and biochemical progression rates were compared between men with and without surgical delay. We used Cox proportional hazards models to examine predictors of biochemical progression.
Of 1,111 men who fulfilled the D'Amico low risk criteria, those with a surgical delay of 6 months or more were significantly older, had a higher proportion of African American men, and a lower proportion of clinical stage T2a (vs T1). A surgical delay of 6 months or more was associated with a greater risk of high grade disease at prostatectomy (p = 0.001) and biochemical progression (p = 0.04). The progression-free survival rate was significantly lower among men with a surgical delay. On multivariate analysis with prostate specific antigen and clinical stage, surgical delays of 6 months or more were significantly and independently associated with time to biochemical progression.
In men who met the D'Amico low risk criteria, a surgical delay of 6 months or more was associated with significantly worse radical prostatectomy outcomes, including more pathology upgrading and a higher rate of biochemical progression. Low risk patients choosing to defer initial definitive therapy should be counseled regarding the possibility of worse treatment outcomes at a later date.
低危前列腺癌患者的治疗选择包括根治性前列腺切除术、放射治疗和主动监测。在接受根治性前列腺切除术的患者中，先前的研究表明，手术延迟 6 个月或更长时间会导致显著更高的生化进展率。我们确定了手术延迟对低危患者根治性前列腺切除术结果的影响。
我们从根治性前列腺切除术数据库中确定了符合 D'Amico 低危标准（临床分期 T1c/T2a、前列腺特异性抗原小于 10ng/ml 和活检 Gleason 6 或更低）的男性。比较了有和没有手术延迟的男性之间的病理肿瘤特征和生化进展率。我们使用 Cox 比例风险模型来检查生化进展的预测因素。
在符合 D'Amico 低危标准的 1111 名男性中，手术延迟 6 个月或更长时间的患者年龄较大，非裔美国人比例较高，临床分期 T2a（与 T1 相比）比例较低。手术延迟 6 个月或更长时间与前列腺切除术后高级别疾病的风险增加（p=0.001）和生化进展（p=0.04）相关。手术延迟的男性无生化进展生存率显著降低。在前列腺特异性抗原和临床分期的多变量分析中，手术延迟 6 个月或更长时间与生化进展的时间显著且独立相关。
在符合 D'Amico 低危标准的男性中，手术延迟 6 个月或更长时间与根治性前列腺切除术结果显著恶化相关，包括更多的病理升级和更高的生化进展率。选择推迟初始确定性治疗的低危患者应告知他们在以后的某个时间点可能会出现更差的治疗结果。
