title: Oncologic outcomes following radical prostatectomy in the active surveillance era.
abstract: OBJECTIVE
  In this study, we examine the oncologic outcomes of men with low, intermediate and high preoperative risk for prostate cancer treated with radical prostatectomy prior to and during the active surveillance era.
  
  
  METHODS
  We analyzed records from patients who underwent radical prostatectomy at our Canadian tertiary care facility from 2000 to 2012. Patients were stratified by D'Amico preoperative risk category and by year of treatment. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method.
  
  
  RESULTS
  We included 2643 consecutive patients in our analysis. The proportion of men with low-risk disease undergoing radical prostatectomy decreased from 2007 onwards coincident with the implementation of an active surveillance strategy in our institution. Men with low-risk and high-risk disease showed significantly worse biochemical outcomes from 2007 to 2012 compared to 2000 to 2006 (p < 0.05), while men with intermediate-risk prostate cancer showed no significant differences (p = 0.27). Within the low-risk cohort, the later treatment group displayed significantly lower age, pre-treatment prostate specific antigen and tumour volume and significantly higher testosterone and body mass index.
  
  
  CONCLUSIONS
  The time period corresponding with the implementation of active surveillance at our institution corresponded with significant deterioration of biochemical outcomes in the low- and high-risk groups. This suggests that the men with most favourable disease deferred treatment, whereas men with worse preoperative disease characteristics were increasingly treated with radical prostatectomy in the past 6 years perhaps to their benefit.
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, ON;
authors.forename: Alyssa S
authors.initials: AS
authors.lastname: Louis
authors.forename: Robin
authors.initials: R
authors.lastname: Kalnin
authors.forename: Manjula
authors.initials: M
authors.lastname: Maganti
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Matthew
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Zlotta
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
authors.forename: Girish
authors.initials: G
authors.lastname: Kulkarni
authors.forename: Robert
authors.initials: R
authors.lastname: Hamilton
authors.forename: Michael
authors.initials: M
authors.lastname: Jewett
authors.forename: Michael
authors.initials: M
authors.lastname: Robinette
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: John
authors.initials: J
authors.lastname: Trachtenberg
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