Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27705, USA.
Prostate. 2013 Mar;73(4):409-17. doi: 10.1002/pros.22582. Epub 2012 Sep 19.
Active surveillance (AS) is increasingly accepted as appropriate management for low-risk prostate cancer (PC) patients. It is unknown whether delaying radical prostatectomy (RP) is associated with increased risk of biochemical recurrence (BCR) for men with intermediate-risk PC.
We performed a retrospective analysis of 1,561 low and intermediate-risk men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with RP between 1988 and 2011. Patients were stratified by interval between diagnosis and RP (≤ 3, 3-6, 6-9, or >9 months) and by risk using the D'Amico classification. Cox proportional hazard models were used to analyze BCR. Logistic regression was used to analyze positive surgical margins (PSM), extracapsular extension (ECE), and pathologic upgrading.
Overall, 813 (52%) men were low-risk, and 748 (48%) intermediate-risk. Median follow-up among men without recurrence was 52.9 months, during which 437 men (38.9%) recurred. For low-risk men, RP delays were unrelated to BCR, ECE, PSM, or upgrading (all P > 0.05). For intermediate-risk men, however, delays >9 months were significantly related to BCR (HR: 2.10, P = 0.01) and PSM (OR: 4.08, P < 0.01). Delays >9 months were associated with BCR in subsets of intermediate-risk men with biopsy Gleason score ≤ 3 + 4 (HR: 2.51, P < 0.01), PSA ≤ 6 (HR: 2.82, P = 0.06), and low tumor volume (HR: 2.59, P = 0.06).
For low-risk men, delayed RP did not significantly affect outcome. For men with intermediate-risk disease, delays >9 months predicted greater BCR and PSM risk. If confirmed in future studies, this suggests delayed RP for intermediate-risk PC may compromise outcomes.
主动监测（AS）越来越被认为是低危前列腺癌（PC）患者的适当治疗方法。目前尚不清楚对于中危 PC 患者，延迟根治性前列腺切除术（RP）是否会增加生化复发（BCR）的风险。
我们对 1988 年至 2011 年间在共享平等获得区域癌症医院（SEARCH）数据库中接受 RP 治疗的 1561 例低危和中危患者进行了回顾性分析。患者根据诊断和 RP 之间的间隔（≤3、3-6、6-9 或>9 个月）以及 D'Amico 分类进行分层。使用 Cox 比例风险模型分析 BCR。使用逻辑回归分析阳性手术切缘（PSM）、包膜外延伸（ECE）和病理升级。
总体而言，813 名（52%）男性为低危，748 名（48%）为中危。无复发患者的中位随访时间为 52.9 个月，期间 437 名（38.9%）患者复发。对于低危男性，RP 延迟与 BCR、ECE、PSM 或升级均无关（均 P > 0.05）。然而，对于中危男性，>9 个月的延迟与 BCR（HR：2.10，P = 0.01）和 PSM（OR：4.08，P < 0.01）显著相关。在中危男性的亚组中，>9 个月的延迟与活检 Gleason 评分≤3+4（HR：2.51，P < 0.01）、PSA≤6（HR：2.82，P = 0.06）和低肿瘤体积（HR：2.59，P = 0.06）相关。
对于低危男性，延迟 RP 不会显著影响结果。对于中危疾病患者，>9 个月的延迟预测 BCR 和 PSM 风险增加。如果在未来的研究中得到证实，这表明延迟 RP 治疗中危 PC 可能会影响结果。
