Oncologic and functional outcomes one year after radical prostatectomy for very low risk prostate cancer. Results from the prospective LAPPRO trial.

OBJECTIVE - To analyse oncological and functional outcomes 12 months after treatment of very low risk prostate cancer with radical prostatectomy in men who could have been candidates for active surveillance.

PATIENTS AND METHODS - A prospective study of all men with very low risk prostate cancer who underwent radical prostatectomy at 14 participating centres.

Validated patient questionnaires were collected at base line and after 12 months by independent health-care researchers. Biochemical recurrence (BCR) was defined as PSA ≥ 0. 25 ng/ml or treatment with salvage radiotherapy or treated with hormones. Urinary continence was defined as "less than one pad changed per 24 hour". Erectile function was defined as "erection hard enough for penetration more than half of the time after sexual stimulation". Changes in tumor grade and stage were obtained from pathology reports. We show descriptive frequencies and proportions having each outcome in various subgroups. Fisher's exact test was used to assess differences between the age groups.

RESULTS - Of the 4003 men in the LAPPRO cohort, 338 men fulfilled the preoperative national criteria for very low risk prostate cancer. Adverse pathology outcomes included: upgrading, defined as pT3 or postoperative Gleason sum ≥ 7, was present in 35% (115/333), positive surgical margins, 16% (54/329). Only 7/329 men (2. 1%) had PSA concentration > 0. 1 ng/ml 6-12 weeks postoperatively. Erectile function and urinary continence were 44% (98/222) and 84% (264/315) 12 months postoperatively. Trifecta defined as preoperative potent and continent men that remained potent and continent with no BCR was at 12 months 38% (84/221).

CONCLUSIONS - Our prospective study of men with very low risk prostate cancer undergoing open or robotic radical prostatectomy showed favourable oncological outcome in about two-thirds. About 40 per cent did not suffer from surgically induced urinary incontinence or erectile dysfunction 12 months postoperatively. These results provide additional support for the use of active surveillance in men with very low risk prostate cancer, however the group of men with risk of upgrading and upstaging is not negligible. Improved stratification is still an urgently needed. This article is protected by copyright. All rights reserved.

BJU international. 2016 Feb 11 [Epub ahead of print]

Stefan Carlsson, Fredrik Jäderling, Anna Wallerstedt, Tommy Nyberg, Johan Stranne, Thordis Thorsteinsdottir, Sigrid V Carlsson, Anders Bjartell, Jonas Hugosson, Eva Haglind, Gunnar Steineck

Department of Molecular Medicine and Surgery, Section of Urology and Radiology, Karolinska Institutet, Stockholm. , Department of Molecular Medicine and Surgery, Section of Urology and Radiology, Karolinska Institutet, Stockholm. , Department of Molecular Medicine and Surgery, Section of Urology and Radiology, Karolinska Institutet, Stockholm. , Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institutet, Stockholm. , Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg. , Faculty of Nursing, School of Health Sciences, University of Iceland. , Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden. , Department of Urology, Skåne University Hospital, Lund University. , Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg. , Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital,, Göteborg, Sweden. , Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden.

PubMed

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