title: Immediate versus delayed radical prostatectomy: updated outcomes following active surveillance of prostate cancer.
abstract: BACKGROUND
  Biopsy progression on active surveillance (AS) for prostate cancer (PCa) often reflects failure of the initial biopsy to detect cancer present at enrollment. The risks for delayed treatment among men who progress on AS are not well defined.
  
  
  OBJECTIVE
  To report outcomes for men who underwent surgery after AS compared to men who underwent immediate surgery and the influence of selection bias on this outcome.
  
  
  METHODS
  AS-eligible (ASE) men who underwent radical prostatectomy (RP) after a median of 20 mo of AS were compared to ASE men who underwent RP within 6 mo of diagnosis. A subset of men on AS who underwent RP after upgrade to Gleason 3+4 was compared to matched controls with similar pretreatment biopsy features who underwent immediate RP.
  
  
  METHODS
  Rates of adverse pathology (upstaging, positive surgical margin, or Gleason upgrading) were examined. Logistic regression was used to determine associations between treatment subgroup and adverse pathology.
  
  
  CONCLUSIONS
  Of 157 ASE men who underwent delayed RP after AS, 54 were upgraded to Gleason 3+4 before surgery. ASE men who underwent immediate RP had lower probability of adverse pathology than ASE men who underwent delayed RP (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.21-0.55). The rate of adverse pathology did not differ between immediate and delayed RP patients matched for pretreatment characteristics (HR 0.79, 95% CI 0.27-2.28). The observational design of this study is its main limitation.
  
  
  CONCLUSIONS
  When compared to men with similar pretreatment biopsy features, those who underwent delayed RP were not at higher risk of adverse pathology.
  
  
  RESULTS
  The oncologic safety of delayed treatment when indicated for men enrolled in active surveillance for prostate cancer is important. We found that men who underwent delayed surgery had similar outcomes to men who underwent immediate prostatectomy.
authors.affiliation: Department of Urology, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Pauline
authors.initials: P
authors.lastname: Filippou
authors.affiliation: Department of Urology, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Welty
authors.affiliation: Department of Urology, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.affiliation: Department of Urology, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Nannette
authors.initials: N
authors.lastname: Perez
authors.affiliation: Department of Urology, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
authors.forename: Katsuto
authors.initials: K
authors.lastname: Shinohara
authors.affiliation: Department of Urology, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. Electronic address: peter.carroll@ucsf.edu.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000368:Aged; D018450:Disease Progression; D006801:Humans; D007610:Kallikreins / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D057832:Watchful Waiting / Q000379:methods*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Active surveillance; Outcomes; Pathology; Prostate cancer; Radical prostatectomy