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Related Concept Videos

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  3. Contemporary Risk Of Biochemical Recurrence After Radical Prostatectomy In The Active Surveillance Era.
  1. Home
  3. Contemporary Risk Of Biochemical Recurrence After Radical Prostatectomy In The Active Surveillance Era.

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Contemporary risk of biochemical recurrence after radical prostatectomy in the active surveillance era.

Sanjay Das1, Michael Luu2, Martha Terris3

  • 1Durham Veterans Affairs Health Care System, Department of Surgery, Durham, NC; Department of Urology, University of California - Los Angeles, Los Angeles, CA; Department of Urology, Cedars-Sinai Medical Center, Los Angeles.

Urologic Oncology
|March 15, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

Biochemical recurrence (BCR) risk after prostatectomy has increased in the active surveillance (AS) era, primarily due to a higher-risk patient mix and elevated BCR rates in high-risk cases. Contemporary BCR estimates are crucial for patient counseling.

Keywords:
“Active surveillance”“Biochemical recurrence”“Prostate cancer”“Radical prostatectomy”

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Area of Science:

  • Urology
  • Oncology
  • Cancer Research

Background:

  • Radical prostatectomy (RP) is a primary treatment for localized prostate cancer (PC).
  • Estimates of biochemical recurrence (BCR) risk after RP are essential for patient counseling and treatment planning.
  • Contemporary BCR risk may differ from historical data due to evolving patient populations and risk stratification methods.

Purpose of the Study:

  • To evaluate if contemporary BCR risks post-RP differ from historical data.
  • To investigate the impact of changes in tumor risk case mix and risk stratification on BCR rates.
  • To provide updated risk information for physicians counseling patients.

Main Methods:

  • Analysis of 6,682 men undergoing RP between 2000-2017 from the VA SEARCH database.
  • Kaplan-Meier analysis to calculate BCR incidence before and after 2010.
  • Multivariable Cox regression with interaction terms to compare BCR risk across eras and risk subgroups.

    • Main Results:

    • Overall BCR risk was higher post-2010 when not accounting for tumor risk, but this difference disappeared after adjustment.
    • BCR risk decreased for favorable and unfavorable intermediate-risk PC post-2010.
    • BCR risk significantly increased for high-risk PC post-2010 (HR: 1.22, 95%CI: 1.07-1.38).
    • Eight-year BCR risks in the post-2010 era varied: 21% (low-risk) to 60% (high-risk).

    Conclusions:

    • Contemporary BCR risk after RP has increased, driven by a higher-risk patient cohort.
    • High-risk prostate cancer patients face a significantly elevated BCR risk in the modern era.
    • Physicians must utilize current BCR estimates for accurate patient counseling.