BACKGROUND: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa). OBJECTIVE: Evaluate pathology findings after RP in our prospective AS cohort. DESIGN, SETTING, AND PARTICIPANTS: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage ≤ T2, prostate-specific antigen [PSA] ≤ 10 ng/ml, PSA density <0.2 ng/ml per ml, one or two positive biopsy cores, and Gleason score ≤ 6) and underwent RP between December 2006 and July 2011. The study protocol recommends RP in case of risk reclassification on repeat biopsy (Gleason score >6 and/or more than two positive cores) or a PSA doubling time ≤ 3 yr. MEASUREMENTS: Descriptive statistics were used to report on pathology findings for staging and grading. RESULTS AND LIMITATIONS: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores ≤ 6, 3+4, 4+3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score ≥ 4+3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP. CONCLUSIONS: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated.
BACKGROUND: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa). OBJECTIVE: Evaluate pathology findings after RP in our prospective AS cohort. DESIGN, SETTING, AND PARTICIPANTS: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage ≤ T2, prostate-specific antigen [PSA] ≤ 10 ng/ml, PSA density <0.2 ng/ml per ml, one or two positive biopsy cores, and Gleason score ≤ 6) and underwent RP between December 2006 and July 2011. The study protocol recommends RP in case of risk reclassification on repeat biopsy (Gleason score >6 and/or more than two positive cores) or a PSA doubling time ≤ 3 yr. MEASUREMENTS: Descriptive statistics were used to report on pathology findings for staging and grading. RESULTS AND LIMITATIONS: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores ≤ 6, 3+4, 4+3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score ≥ 4+3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP. CONCLUSIONS: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated.
Authors: H Ballentine Carter; Alan W Partin; Patrick C Walsh; Bruce J Trock; Robert W Veltri; William G Nelson; Donald S Coffey; Eric A Singer; Jonathan I Epstein Journal: J Clin Oncol Date: 2012-10-01 Impact factor: 44.544
Authors: Andreas Becker; Daniel Seiler; Maciej Kwiatkowski; Luis Alex Kluth; Dietrich Schnell; Markus Graefen; Thorsten Schlomm; Margit Fisch; Franz Recker; Lothar Weissbach; Felix K H Chun Journal: World J Urol Date: 2014-05-13 Impact factor: 4.226
Authors: Daniel A Galvão; Dennis R Taaffe; Nigel Spry; Robert A Gardiner; Renea Taylor; Gail P Risbridger; Mark Frydenberg; Michelle Hill; Suzanne K Chambers; Phillip Stricker; Tom Shannon; Dickon Hayne; Eva Zopf; Robert U Newton Journal: Nat Rev Urol Date: 2016-03-08 Impact factor: 14.432
Authors: Jeri Kim; James Ebertowski; Matthew Janiga; Jorge Arzola; Gayle Gillespie; Michael Fountain; Douglas Soderdahl; Edith Canby-Hagino; Sally Elsamanoudi; Jennifer Gurski; John W Davis; Patricia A Parker; Douglas D Boyd Journal: BJU Int Date: 2013-01-25 Impact factor: 5.588