Rohith Arcot, Michael L Cher, Ji Qi, Susan M Linsell, Rodney L Dunn, Arvin K George, James E Montie, Kevin B Ginsburg
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Time to secondary treatment was estimated using Kaplan-Meier curves and compared using the log-rank test. A multivariable Cox proportional hazards model was fit to assess the association between timing of RP and use of secondary treatments. A chi-squared test was used to assess the association between delayed RP and adverse pathology.</p><p><strong>Results: </strong>We identified 1878 men that underwent an RP during the study period, of which 1489 (79%) underwent immediate RP and 389 (21%) underwent delayed RP. The incidence of adverse pathology was higher in men with delayed versus immediate RP (49% vs. 36%, p < 0.0001, respectively). However, we noted only a small absolute difference in the estimated 24-month secondary treatment-free probability between men with delayed versus immediate RP (93% and 96%, respectively). On multivariable analysis, delayed RP was associated with increased use of secondary treatments (hazard ratio = 1.94, 95% confidence interval = 1.23-3.06, p = 0.004).</p><p><strong>Conclusions: </strong>The use of secondary treatment after RP in men with GG1 PC undergoing immediate or delayed prostatectomy was rare. These data suggest that the burden of treatment is near equivalent in patients who progress to treatment on AS compared with those who underwent immediate RP.</p>","PeriodicalId":501684,"journal":{"name":"The Prostate","volume":" ","pages":"323-329"},"PeriodicalIF":0.0000,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Delayed radical prostatectomy after a period of active surveillance is not associated with the use of secondary treatments compared with immediate prostatectomy.\",\"authors\":\"Rohith Arcot, Michael L Cher, Ji Qi, Susan M Linsell, Rodney L Dunn, Arvin K George, James E Montie, Kevin B Ginsburg\",\"doi\":\"10.1002/pros.24277\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We evaluated the use of secondary treatments in men with grade group (GG) 1 PC following a period of active surveillance (AS) compared with men undergoing immediate radical prostatectomy (RP) to evaluate what is potentially lost in terms of cancer control, if a patient trials AS and transitions to treatment.</p><p><strong>Methods: </strong>We reviewed the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men with GG1 PC undergoing RP from April 2012 to July 2018. Men were classified into groups based on time from diagnosis to RP: immediate (surgery within 1 year of diagnosis) and delayed RP (surgery >1 year after initiation of AS). Time to secondary treatment was estimated using Kaplan-Meier curves and compared using the log-rank test. A multivariable Cox proportional hazards model was fit to assess the association between timing of RP and use of secondary treatments. A chi-squared test was used to assess the association between delayed RP and adverse pathology.</p><p><strong>Results: </strong>We identified 1878 men that underwent an RP during the study period, of which 1489 (79%) underwent immediate RP and 389 (21%) underwent delayed RP. The incidence of adverse pathology was higher in men with delayed versus immediate RP (49% vs. 36%, p < 0.0001, respectively). However, we noted only a small absolute difference in the estimated 24-month secondary treatment-free probability between men with delayed versus immediate RP (93% and 96%, respectively). On multivariable analysis, delayed RP was associated with increased use of secondary treatments (hazard ratio = 1.94, 95% confidence interval = 1.23-3.06, p = 0.004).</p><p><strong>Conclusions: </strong>The use of secondary treatment after RP in men with GG1 PC undergoing immediate or delayed prostatectomy was rare. 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引用次数: 1
摘要
背景:我们评估了在一段时间的主动监测(AS)后，与接受立即根治性前列腺切除术(RP)的男性相比，GG组(GG) 1级前列腺癌患者使用二次治疗的情况，以评估如果患者试验AS并过渡到治疗，在癌症控制方面可能失去的东西。方法:我们回顾了2012年4月至2018年7月密歇根泌尿外科改进协作(MUSIC)登记的GG1 PC患者接受RP的男性。根据从诊断到RP的时间将男性分为两组:立即(诊断1年内手术)和延迟RP(开始AS后>1年手术)。使用Kaplan-Meier曲线估计到二次治疗的时间，并使用log-rank检验进行比较。采用多变量Cox比例风险模型评估RP时间与二次治疗使用之间的关系。采用卡方检验评估延迟性RP与不良病理之间的关系。结果:我们在研究期间确定了1878名接受RP的男性，其中1489名(79%)接受了立即RP, 389名(21%)接受了延迟RP。延迟性RP的男性不良病理发生率高于立即性RP (49% vs. 36%)。结论:在接受立即或延迟性前列腺切除术的GG1型PC患者中，RP后使用二次治疗是罕见的。这些数据表明，与立即接受RP治疗的患者相比，进展到AS治疗的患者的治疗负担几乎相同。
Delayed radical prostatectomy after a period of active surveillance is not associated with the use of secondary treatments compared with immediate prostatectomy.
Background: We evaluated the use of secondary treatments in men with grade group (GG) 1 PC following a period of active surveillance (AS) compared with men undergoing immediate radical prostatectomy (RP) to evaluate what is potentially lost in terms of cancer control, if a patient trials AS and transitions to treatment.
Methods: We reviewed the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men with GG1 PC undergoing RP from April 2012 to July 2018. Men were classified into groups based on time from diagnosis to RP: immediate (surgery within 1 year of diagnosis) and delayed RP (surgery >1 year after initiation of AS). Time to secondary treatment was estimated using Kaplan-Meier curves and compared using the log-rank test. A multivariable Cox proportional hazards model was fit to assess the association between timing of RP and use of secondary treatments. A chi-squared test was used to assess the association between delayed RP and adverse pathology.
Results: We identified 1878 men that underwent an RP during the study period, of which 1489 (79%) underwent immediate RP and 389 (21%) underwent delayed RP. The incidence of adverse pathology was higher in men with delayed versus immediate RP (49% vs. 36%, p < 0.0001, respectively). However, we noted only a small absolute difference in the estimated 24-month secondary treatment-free probability between men with delayed versus immediate RP (93% and 96%, respectively). On multivariable analysis, delayed RP was associated with increased use of secondary treatments (hazard ratio = 1.94, 95% confidence interval = 1.23-3.06, p = 0.004).
Conclusions: The use of secondary treatment after RP in men with GG1 PC undergoing immediate or delayed prostatectomy was rare. These data suggest that the burden of treatment is near equivalent in patients who progress to treatment on AS compared with those who underwent immediate RP.
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