Eligibility for active surveillance and pathological outcomes for men undergoing radical prostatectomy in a large, community based cohort.

PURPOSE: We analyzed competing active surveillance criteria in men who underwent radical prostatectomy in relation to outcome data in a large, community based cohort.
MATERIALS AND METHODS: We identified all men from the CaPSURE database who underwent radical prostatectomy from 1999 to 2007 and met inclusion criteria for the stringent prospective University of California-San Francisco and Johns Hopkins active surveillance protocols. Rates of pathological upgrading, up staging and biochemical recurrence were compared.
RESULTS: We identified 2,837 men who underwent radical prostatectomy and had complete pathological and followup data available. Of these men 1,375 and 125 met University of California-San Francisco and Johns Hopkins criteria, respectively. When comparing men who met the 2 sets of criteria vs those who met University of California-San Francisco criteria only, there were no significant differences in the rate of upgrading (20% vs 27%, p = 0.07) and up staging (6% vs 8%, p = 0.39) at radical prostatectomy. At a median 36-month followup 5-year biochemical recurrence-free estimates were similar at 92% in men who met the 2 sets of criteria and 90% in those who met the University of California-San Francisco definition only. On multivariate analysis upgrading to 7 or greater (HR 2.2, 95% CI 1.2-4.2), up staging (HR 3.5, 95% CI 1.3-9.3), and upgrading plus up staging (HR 6.9, 95% CI 3.3-14.5) were associated with a higher risk of biochemical recurrence in patients who met University of California-San Francisco criteria.
CONCLUSIONS: Men who met enrollment criteria for the 2 active surveillance protocols had a similar rate of upgrading, up staging and 5-year biochemical recurrence-free rates after radical prostatectomy. Further comparison between current protocols is warranted to establish universal inclusion criteria.