Re: Delay of surgery in men with low risk prostate cancer: D. O'Brien, S. Loeb, G. F. Carvalhal, B. B. McGuire, D. Kan, M. D. Hofer, J. T. Casey, B. T. Helf and W. J. Catalona. J Urol 2011; 185: 2143-2147.

摘要

This study purports to demonstrate that delayed management of low risk prostate cancer is associated with pathological upgrading and a higher rate of biochemical progression. The study is retrospective, comparing the pathological and clinical outcomes of men with low risk disease who underwent immediate radical prostatectomy vs delayed surgery. Median time from diagnosis to surgery was 2.4 vs 15.6 months.Association does not mean causation, and patient selection often accounts for differences in outcome. The authors do not describe the reason for the surgical delay. Perhaps the delayed cases were managed initially by surveillance but exhibited some adverse clinical feature, ie poor prostate specific antigen (PSA) kinetics or a change on imaging. As such, these patients would represent a cohort selected for higher risk, and not surprisingly would have worse pathological findings and a higher PSA progression rate. Without information about the cause of the delayed treatment or the true denominator of patients with favorable risk prostate cancer in their community, it is impossible to know whether this is the situation.