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Title: Does active surveillance avoid overtreatment in prostate cancer? Lessons learned from salvage radical prostatectomies.
Austin Authors: Polo Alonso, E;Ramírez-Backhaus, M;Wei, Gavin ;Mascarós, J M;Aragón Rodríguez, F;Gómez-Ferrer, A;Collado, A;Calatrava Fons, A;Rubio-Briones, J
Affiliation: Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España
Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia
Surgery (University of Melbourne)
Departamento de Patología, Fundacion Instituto Valenciano de Oncología, Valencia, España
Issue Date: 23-Feb-2021 2021-02-23
Publication information: Actas Urologicas Espanolas 2021; online first: 23 February
Abstract: Determine whether our institution's active surveillance (AS) protocol is a suitable strategy to minimise prostate cancer overtreatment. Retrospective analysis of 516 patients on AS after prostate cancer diagnosis. Population divided into «per-protocol» vs «induced» AS depending on fulfilment of protocol's inclusion criteria. Radical prostatectomies after AS were selected and stratified based on reclassification, progression or patient anxiety. Clinicopathological features and biochemical relapse-free survival were studied. Primary endpoint was overtreatment ratio based on the presence of insignificant prostate cancer and adverse pathological features in the surgical specimen. Kaplan-Meier curves were used to estimate the biochemical relapse-free survival and compared with log-rank test. 304 patients fulfilled inclusion criteria; 100 proceeded to radical prostatectomy (31% «induced», 69% «per-protocol» AS). Surgery indications were reclassification, progression and anxiety in 66%, 18% and 16% of patients, respectively. Rate of positive lymph nodes was higher in the progression group (11%) compared to reclassification and anxiety (5% and 0%, respectively; P=.002). Positive surgical margins were more frequently reported in the progression cohort compared to reclassification (28% vs 20%). Median follow-up from diagnosis until last radical prostatectomy was 48.3months (32.4-70). Three year biochemical relapse-free survival in the salvage radical prostatectomy was 85.4% (95%CI: 78.3-93.2). Insignificant cancer was noticed in 7% of patients (Epstein's vs 24% Wolters' criteria). Rate of patients with adverse pathological features was 36%. The majority of patients who underwent salvage surgery after AS were not overtreated. Radical prostatectomy should be considered a safe rescue treatment.
DOI: 10.1016/j.acuro.2020.09.010
PubMed URL: 33637376
Type: Journal Article
Subjects: Active surveillance
Disease progression
Neoplasias Prostáticas
Progresión de la enfermedad
Prostatic neoplasms
Vigilancia activa
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