For men with localized low-risk prostate cancer, there is no rush to decide on a treatment option, according to the National Prostate Cancer Register (NPCR) of Sweden Follow-up Study published online in the Journal of Urology. This suggestion is based on findings that after median follow-up of 8 years, men who underwent prompt radical prostatectomy had no significant difference in the presence of one of three adverse pathology features or in prostate cancer–specific mortality than men who deferred surgery for up to 19 months.
Researchers, on behalf of the NPCR of Sweden, assessed these clinical outcomes in men who underwent primary or deferred radical prostatectomy. Patients were aged ≤70 years at diagnosis and had localized low- to intermediate-risk prostate cancer. Adverse pathology was defined as (1) upgrade in Gleason score, (2) positive surgical margins, and/or (3) extraprostatic extension. The researchers identified and assessed 2344 men who underwent primary prostatectomy and 222 who underwent deferred prostatectomy; all were diagnosed between 1997 and 2002.
Upgrading of Gleason score was less frequent after primary (25%) compared with deferred (38%) radical prostatectomy (P <.001). No significant difference was found between the groups for positive surgical margins (33% vs 24%, respectively) or for extraprostatic extension (27% vs 25%, respectively). Values for any one or more of the three pathology features were 55% for primary compared with 56% for deferred radical prostatectomy. The researchers noted that longer follow-up is needed to conclusively evaluate the role of deferred radical prostatectomy.