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Immediate versus delayed prostatectomy: Nationwide population-based study
NYU, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Umea Univ Hosp, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden.;Ryhov Cty Hosp, Dept Urol, Jonkoping, Sweden..
NYU, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
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2016 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 4, 246-254 p.Article in journal (Refereed) PublishedText
Abstract [en]

Objective: The aim of this study was to compare the outcome of immediate versus delayed radical prostatectomy (RP) in men with low-grade prostate cancer. Materials and methods: The study included a nationwide population-based cohort in the National Prostate Cancer Register of Sweden, of 7608 men with clinically localized, biopsy Gleason score 6 prostate cancer who underwent immediate or delayed RP in 1997-2007. Multivariable models compared RP pathology, use of salvage radiotherapy and prostate cancer mortality based on timing of RP (< 1, 1-2 or > 2 years after diagnosis). Median follow-up was 8.1 years. Results: Men undergoing RP more than 2 years after diagnosis had a higher risk of Gleason upgrading [odds ratio 2.93, 95% confidence interval (CI) 2.34-3.68] and an increased risk of salvage radiotherapy [hazard ratio (HR) 1.90, 95% CI 1.41-2.55], but no significant increase in prostate cancer-specific mortality (HR 1.85, 95% CI 0.57-5.99). In competing risk analysis, 7 year prostate cancer-specific cumulative mortality was similar, at less than 1%, for immediate RP and active surveillance regardless of later intervention. Limitations of this study include the lack of data on follow-up biopsies and the limited follow-up time. Conclusion: Men undergoing RP more than 2 years after diagnosis had more adverse pathological features and second line therapy, highlighting the trade-off in deferring immediate curative therapy. However, men with delayed RP constitute a minority with higher risk cancer among the much larger group of low-risk men initially surveilled, and the overall risk of prostate cancer mortality at 7 years was similarly low with immediate RP or active surveillance.

Place, publisher, year, edition, pages
2016. Vol. 50, no 4, 246-254 p.
Keyword [en]
Active surveillance, outcomes, prognosis, prostate cancer, radical prostatectomy, surgical delay
National Category
Surgery Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-300103DOI: 10.3109/21681805.2016.1166153ISI: 000379024000002PubMedID: 27067998OAI: oai:DiVA.org:uu-300103DiVA: diva2:950812
Funder
Swedish Research Council, 825-2012-5047Swedish Cancer Society, 11 0471 2012/475NIH (National Institute of Health), K07CA178258
Available from: 2016-08-02 Created: 2016-08-02 Last updated: 2016-08-02Bibliographically approved

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Stattin, Pär
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