title: Immediate versus delayed prostatectomy: Nationwide population-based study (.).
abstract: OBJECTIVE
  The aim of this study was to compare the outcome of immediate versus delayed radical prostatectomy (RP) in men with low-grade prostate cancer.
  
  
  METHODS
  The study included a nationwide population-based cohort in the National Prostate Cancer Register of Sweden, of 7608 men with clinically localized, biopsy Gleason score 6 prostate cancer who underwent immediate or delayed RP in 1997-2007. Multivariable models compared RP pathology, use of salvage radiotherapy and prostate cancer mortality based on timing of RP (< 1, 1-2 or >2 years after diagnosis). Median follow-up was 8.1 years.
  
  
  RESULTS
  Men undergoing RP more than 2 years after diagnosis had a higher risk of Gleason upgrading [odds ratio 2.93, 95% confidence interval (CI) 2.34-3.68] and an increased risk of salvage radiotherapy [hazard ratio (HR) 1.90, 95% CI 1.41-2.55], but no significant increase in prostate cancer-specific mortality (HR 1.85, 95% CI 0.57-5.99). In competing risk analysis, 7 year prostate cancer-specific cumulative mortality was similar, at less than 1%, for immediate RP and active surveillance regardless of later intervention. Limitations of this study include the lack of data on follow-up biopsies and the limited follow-up time.
  
  
  CONCLUSIONS
  Men undergoing RP more than 2 years after diagnosis had more adverse pathological features and second line therapy, highlighting the trade-off in deferring immediate curative therapy. However, men with delayed RP constitute a minority with higher risk cancer among the much larger group of low-risk men initially surveilled, and the overall risk of prostate cancer mortality at 7 years was similarly low with immediate RP or active surveillance.
authors.affiliation: a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA ;
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.affiliation: b Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital , Uppsala , Sweden ;
authors.forename: Yasin
authors.initials: Y
authors.lastname: Folkvaljon
authors.affiliation: c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden ;|d Department of Urology , Ryhov County Hospital , Jönköping , Sweden ;
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.affiliation: a New York University and Manhattan Veterans Affairs Medical Center , New York , NY , USA ;
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.affiliation: e Department of Urology, CamPARI Clinic , Addenbrooke's Hospital , Cambridge , UK ;|f Department of Translational Sciences , Lund University , Lund , Sweden ;
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
authors.affiliation: g Faculty of Life Sciences and Medicine, Division of Cancer Studies , King's College London , London , UK ;
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: c Department of Surgery and Perioperative Sciences, Urology and Andrology , Umeå University Hospital , Umeå , Sweden ;|h Department of Surgical Sciences , Uppsala University , Uppsala , Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012042:Registries; D013548:Sweden; D061665:Time-to-Treatment
keywords: Active surveillance; outcomes; prognosis; prostate cancer; radical prostatectomy; surgical delay