title: Outcome of primary versus deferred radical prostatectomy in the National Prostate Cancer Register of Sweden Follow-Up Study.
abstract: OBJECTIVE
  We assessed outcomes in terms of adverse pathology and prostate cancer specific mortality in men who underwent primary or deferred radical prostatectomy.
  
  
  METHODS
  In the National Prostate Cancer Register of Sweden Follow-Up Study men 70 years old or younger at diagnosis with localized low to intermediate risk prostate cancer diagnosed from 1997 to 2002 were identified. Outcome in terms of adverse pathology, namely upgrading of Gleason score, positive surgical margins and extraprostatic extension, as well as prostate cancer specific mortality, was assessed in 2,344 men who underwent primary radical prostatectomy and 222 who underwent deferred radical prostatectomy after an initial period of surveillance.
  
  
  RESULTS
  Upgrading of Gleason score in surgical specimens vs core biopsies was less frequent after primary (25%) vs deferred radical prostatectomy (38%), p <0.001. There was no significant difference in the percentage of men who underwent primary vs deferred radical prostatectomy for positive surgical margins (33% vs 24%) or extraprostatic extension (27% vs 25%), and there was no difference in any 1 or more of the 3 adverse pathology features (55% vs 56%). After a median followup of 8 years 0.7% of men in the primary radical prostatectomy group and 0.9% in the deferred radical prostatectomy group had died of prostate cancer.
  
  
  CONCLUSIONS
  There was no significant difference in the presence of any 1 or more adverse pathology features or in prostate cancer specific mortality after primary compared to deferred radical prostatectomy. However, longer followup is needed to conclusively evaluate the role of deferred radical prostatectomy.
authors: Department of Surgery, Gävle Hospital, Gävle, Sweden. benny.holmstrom@lg.com
authors: Benny
authors: B
authors: Holmström
authors: Erik
authors: E
authors: Holmberg
authors: Lars
authors: L
authors: Egevad
authors: Jan
authors: J
authors: Adolfsson
authors: Jan-Erik
authors: JE
authors: Johansson
authors: Jonas
authors: J
authors: Hugosson
authors: Pär
authors: P
authors: Stattin
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012042:Registries; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome