No significant adverse effects after deferring radical prostatectomy
MedWire News: Men with prostate cancer do not have more adverse disease features if they undergo radical prostatectomy after a period of active surveillance, instead of immediately after diagnosis, say Swedish researchers.
Furthermore, deferring surgery does not increase rates of prostate cancer-specific mortality, reports the team, and overall rates of death from competing causes are higher than rates of death from prostate cancer among both deferred, and immediately treated men.
"Our study indicates that most men with low to intermediate risk prostate cancer who die during follow-up die of other causes regardless of treatment strategy," report Benny Holmström, from Gälve Hospital and colleagues.
The team compared incidence of Gleason score upgrading, positive surgical margins, extracapsular extension, and prostate cancer death among 2344 men who underwent primary radical prostatectomy a median of 3.5 months from diagnosis, and 222 men who underwent deferred surgery after a median of 19.2 months of active surveillance.
Only the difference in the number of patients upgraded to a Gleason score of 7 or higher at surgery was significant. Compared with core biopsy results, surgical specimens were upgraded less often after primary than after deferred surgery, at 25% versus 38%, giving an odds ratio of 2.4 for being upgraded to a Gleason score of 7 or higher after deferring surgery.
In contrast, there were no differences in the proportion of positive surgical margins (33% and 24%), extracapsular extension (27% and 25%), or in having any of the three adverse pathologies (55% and 56%) between primary and deferred prostatectomy patients, respectively.
After a median 8.2 years from diagnosis, 16 (0.7%) of the primary-treated patients and two (0.9%) of the deferred prostatectomy patients had died of prostate cancer, illustrating no differences in prostate-specific health between the groups of men.
However, the rates of death from competing causes were more than double in the deferred surgery group (17%) compared with the primary prostatectomy group (7%), "revealing a strong selection bias for healthy men with more aggressive tumors to undergo [immediate] radical prostatectomy," write Holmström et al in the Journal of Urology.
The team believes longer follow-up is needed to conclusively evaluate the role of deferred surgery.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Sarah Guy