Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes
Biochemical recurrence (BCR) following radical prostatectomy (RP) is an unreliable predictor of prostate cancer (PC) progression. This study was a retrospective cohort analysis of prospectively collected data (407/1895) of men with BCR at a tertiary referral center. Patients were assessed for active...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/17/4078 |
| _version_ | 1797496179197476864 |
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| author | Erica Huang Linda My Huynh Joshua Tran Adam M. Gordon Ryan Chandhoke Blanca Morales Douglas Skarecky Thomas E. Ahlering |
| author_facet | Erica Huang Linda My Huynh Joshua Tran Adam M. Gordon Ryan Chandhoke Blanca Morales Douglas Skarecky Thomas E. Ahlering |
| author_sort | Erica Huang |
| collection | DOAJ |
| description | Biochemical recurrence (BCR) following radical prostatectomy (RP) is an unreliable predictor of prostate cancer (PC) progression. This study was a retrospective cohort analysis of prospectively collected data (407/1895) of men with BCR at a tertiary referral center. Patients were assessed for active observation (AO) compared with a treatment group (TG) utilizing doubling time (DT) kinetics. Risk assessment was based on the initial DT (>12 vs. <12 months), then based on the DT pattern (changed over time). Those with unstable, rapidly decreasing DTs received treatment. Those with increasing and slowly decreasing DTs prompted observation. The primary outcome was PC mortality, safety, and efficacy of observations based on DT kinetics. The secondary outcome was BCR patients managed with or without treatment. The median follow-up was 7.5 years (IQR 3.9–10.7). The PCSM in TG and AO was 10.7% and 0%, respectively (<i>p</i> < 0.001). The initial DT was >12 months in 73.6% of AO versus 22.6% of TG (<i>p</i> < 0.001). An increasing DT pattern was observed in 71.5% of AO versus 32.7% of TG (<i>p</i> < 0.001). Utilizing the Cleveland Clinic’s PCSM nomogram, at 10 years, predicted and observed PCSM was 8.6% and 9.5% (<i>p</i> = 0.78), respectively. In conclusion, one-third of patients with BCR post-RP were managed without treatment using DT kinetics, avoiding treatment-related complications, quality-of-life issues, and expenses. |
| first_indexed | 2024-03-10T01:59:59Z |
| format | Article |
| id | doaj.art-930f705bff244df890e12d5946915d43 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:59:59Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-930f705bff244df890e12d5946915d432023-11-23T12:49:30ZengMDPI AGCancers2072-66942022-08-011417407810.3390/cancers14174078Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of OutcomesErica Huang0Linda My Huynh1Joshua Tran2Adam M. Gordon3Ryan Chandhoke4Blanca Morales5Douglas Skarecky6Thomas E. Ahlering7Department of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USADepartment of Urology, University of California, Orange, CA 92868, USABiochemical recurrence (BCR) following radical prostatectomy (RP) is an unreliable predictor of prostate cancer (PC) progression. This study was a retrospective cohort analysis of prospectively collected data (407/1895) of men with BCR at a tertiary referral center. Patients were assessed for active observation (AO) compared with a treatment group (TG) utilizing doubling time (DT) kinetics. Risk assessment was based on the initial DT (>12 vs. <12 months), then based on the DT pattern (changed over time). Those with unstable, rapidly decreasing DTs received treatment. Those with increasing and slowly decreasing DTs prompted observation. The primary outcome was PC mortality, safety, and efficacy of observations based on DT kinetics. The secondary outcome was BCR patients managed with or without treatment. The median follow-up was 7.5 years (IQR 3.9–10.7). The PCSM in TG and AO was 10.7% and 0%, respectively (<i>p</i> < 0.001). The initial DT was >12 months in 73.6% of AO versus 22.6% of TG (<i>p</i> < 0.001). An increasing DT pattern was observed in 71.5% of AO versus 32.7% of TG (<i>p</i> < 0.001). Utilizing the Cleveland Clinic’s PCSM nomogram, at 10 years, predicted and observed PCSM was 8.6% and 9.5% (<i>p</i> = 0.78), respectively. In conclusion, one-third of patients with BCR post-RP were managed without treatment using DT kinetics, avoiding treatment-related complications, quality-of-life issues, and expenses.https://www.mdpi.com/2072-6694/14/17/4078prostate cancerbiochemical recurrenceradiation therapyandrogen deprivation therapyhormonal therapysalvage therapy |
| spellingShingle | Erica Huang Linda My Huynh Joshua Tran Adam M. Gordon Ryan Chandhoke Blanca Morales Douglas Skarecky Thomas E. Ahlering Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes Cancers prostate cancer biochemical recurrence radiation therapy androgen deprivation therapy hormonal therapy salvage therapy |
| title | Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes |
| title_full | Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes |
| title_fullStr | Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes |
| title_full_unstemmed | Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes |
| title_short | Active Observation of Biochemical Recurrence without Treatment following Radical Prostatectomy: Long-Term Analysis of Outcomes |
| title_sort | active observation of biochemical recurrence without treatment following radical prostatectomy long term analysis of outcomes |
| topic | prostate cancer biochemical recurrence radiation therapy androgen deprivation therapy hormonal therapy salvage therapy |
| url | https://www.mdpi.com/2072-6694/14/17/4078 |
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