OBJECTIVE: Active surveillance (AS) for low-risk prostate cancer represents an acceptable management strategy especially for older patients.
We determined pathologic and oncologic outcomes of patients diagnosed with low-risk prostate cancer in two age cohorts who underwent radical prostatectomy (RP) and qualified for AS according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria.
MATERIALS AND METHODS: A total of 320 patients ≥ 65 years of age who underwent RP and were eligible for AS according to PRIAS criteria were propensity score matched 1:1 to patients < 65 years of age. Patient characteristics were compared with chi-square, Kruskal-Wallis, and one-way ANOVA tests. Predictors of RP pathologic upgrading or upstaging were analyzed using logistic regression. Recurrence-free survival (RFS) and overall survival (OS) were calculated with the Kaplan-Meier method. Predictors of RFS were analyzed within Cox regression models.
RESULTS: Pathologic upgrading and upstaging were significantly higher among older (≥ 65 yrs) versus younger (< 65 yrs) patients (53.1% vs. 44.1% and 12.2% vs. 7.2%, respectively). Higher PSA and increasing age were independent predictors of upgrading among patients < 65 years. There were no differences in RFS or OS between the two age groups. Positive surgical margin status was the only independent predictor of shorter RFS.
CONCLUSIONS: Patients ≥ 65 years of age who are eligible for AS by PRIAS criteria have a higher risk of being upgraded and upstaged at the time of RP compared to patients < 65 years of age. These findings should be taken into consideration when discussing treatment options for patients diagnosed with prostate cancer.
Written by:
Busch J, Magheli A, Leva N, Ferrari M, Kramer J, Klopf C, Kempkensteffen C, Miller K, Brooks JD, Gonzalgo ML. Are you the author?
Department of Urology, Charité University Medicine Berlin, Germany.
Reference: BJU Int. 2013 Sep 20. Epub ahead of print.
doi: 10.1111/bju.12466
PubMed Abstract
PMID: 24112652
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