Long-Term Follow-Up after Prostatectomy for Prostate Cancer and the Need for Active Monitoring.
Journal
Prostate cancer
ISSN: 2090-3111
Titre abrégé: Prostate Cancer
Pays: Egypt
ID NLM: 101567074
Informations de publication
Date de publication:
2020
2020
Historique:
received:
17
09
2019
revised:
12
11
2019
accepted:
06
12
2019
entrez:
2
4
2020
pubmed:
2
4
2020
medline:
2
4
2020
Statut:
epublish
Résumé
Only truly long-term follow-up can determine the ultimate outcome in prostate cancer. Most studies have a median follow-up of less than 10 years and then project outcomes out to 15 and 20 years. We sought to follow patients for at least 20 years. With the factors of PSA, Gleason score, and extraprostatic extension/margin positivity, we could partition patients into three risk groups for biochemical failure (low, intermediate, and high). In further analysis, we found that the risk of metastatic disease in the first two groups was almost identical (4% and 5%, respectively), while it was 19% in the high-risk group. High-risk patients were those with PSA >20 ng/ml and/or Gleason >7, or Gleason 7 + PSA 10-20 + epe (and or margin) positive. They had a 22% prostate cancer mortality. In patients with truly long-term follow-up after prostatectomy for prostate cancer, the risk of metastatic disease and cancer death is very low. Patients with the lower risk findings do not appear to benefit from routine follow-up after 10 years free of biochemical recurrence. With a higher risk of later failure, we recommend that the higher risk patients be followed at least intermittently for another 5 years (out to 15 years).
Sections du résumé
BACKGROUND
BACKGROUND
Only truly long-term follow-up can determine the ultimate outcome in prostate cancer. Most studies have a median follow-up of less than 10 years and then project outcomes out to 15 and 20 years. We sought to follow patients for at least 20 years.
RESULTS
RESULTS
With the factors of PSA, Gleason score, and extraprostatic extension/margin positivity, we could partition patients into three risk groups for biochemical failure (low, intermediate, and high). In further analysis, we found that the risk of metastatic disease in the first two groups was almost identical (4% and 5%, respectively), while it was 19% in the high-risk group. High-risk patients were those with PSA >20 ng/ml and/or Gleason >7, or Gleason 7 + PSA 10-20 + epe (and or margin) positive. They had a 22% prostate cancer mortality.
CONCLUSION
CONCLUSIONS
In patients with truly long-term follow-up after prostatectomy for prostate cancer, the risk of metastatic disease and cancer death is very low. Patients with the lower risk findings do not appear to benefit from routine follow-up after 10 years free of biochemical recurrence. With a higher risk of later failure, we recommend that the higher risk patients be followed at least intermittently for another 5 years (out to 15 years).
Identifiants
pubmed: 32231799
doi: 10.1155/2020/7196189
pmc: PMC7085821
doi:
Types de publication
Journal Article
Langues
eng
Pagination
7196189Informations de copyright
Copyright © 2020 Gregory P. Swanson et al.
Déclaration de conflit d'intérêts
The authors declare that they have no conflicts of interest.
Références
J Urol. 2011 Mar;185(3):869-75
pubmed: 21239008
Urol Oncol. 2014 Jan;32(1):28.e1-9
pubmed: 23433893
J Urol. 2008 Dec;180(6):2453-7; discussion 2458
pubmed: 18930488
Urol Oncol. 2007 Mar-Apr;25(2):110-4
pubmed: 17349524
Am J Surg Pathol. 2005 Sep;29(9):1228-42
pubmed: 16096414
J Clin Oncol. 2015 Jan 20;33(3):272-7
pubmed: 25512465
J Cancer. 2010 Dec 07;2:1-19
pubmed: 21197260