Definitive Pathology at Radical Prostatectomy Is Commonly Favorable in Men Following Initial Active Surveillance

• Published in: European urology 2014-08, Vol.66 (2), p.214-219
• Main Authors: Hong, Sung Kyu, Sternberg, Itay A, Keren Paz, Gal E, Kim, Philip H, Touijer, Karim A, Scardino, Peter T, Eastham, James A
• Format: Article
• Language: English
• Subjects: Active surveillance; Aged; Biological and medical sciences; Biopsy; Gynecology. Andrology. Obstetrics; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local - blood; Nephrology. Urinary tract diseases; Patient Preference; Prostate; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic neoplasms; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Retrospective Studies; Seminal Vesicles - pathology; Tumor Burden; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Watchful Waiting
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2013.08.001

Abstract Background Limited data are currently available regarding the outcomes of radical prostatectomy (RP) in men with low-risk prostate cancer who were initially managed by active surveillance (AS). Objective To evaluate the pathologic outcomes of patients who underwent RP following initial AS. Design, setting, and participants We analyzed the records of 67 patients who underwent RP following initial AS begun between 1993 and 2011. All patients underwent confirmatory biopsy to reassess eligibility for AS. RP was recommended for disease progression suggested by follow-up biopsies or imaging. Outcome measurements and statistical analysis Unfavorable disease was defined as having at least one of the following pathologic findings: Gleason score (GS) ≥4 + 3, extracapsular extension of tumor, seminal vesicle invasion, or lymph node involvement. A descriptive analysis was performed to assess pathologic features. Results and limitations Median time from confirmatory biopsy to RP was 1.7 yr (range: 0.3–7.8). Reasons for discontinuing AS to undergo RP included evidence of increased tumor volume or grade on follow-up biopsy, patient preference/anxiety, and findings on follow-up imaging in 46 patients (68.7%), 17 patients (25.3%), and 4 patients (6.0%), respectively. Pathologic analyses revealed organ-confined disease in 55 patients (82.1%), and GS was ≥4 + 3 in 9 (13.4%). Positive nodes were observed in three patients (4.4%) and positive surgical margin in two (3.0%). Overall, 19 patients (28.4%) had unfavorable disease. Of the biopsy criteria for triggering RP, Gleason patterns >3 were the most frequently associated with unfavorable disease (43.3%). One patient (1.5%) experienced biochemical recurrence during postoperative follow-up (median: 3.2 yr). Our study may be limited by its retrospective and single-institution nature. Conclusions Most patients who started initially on AS after undergoing confirmatory biopsy showed pathologically organ-confined disease with a low GS at RP. Such findings provide further evidence that, overall, AS is a safe treatment approach.