Sung Kyu Hong1, Itay A Sternberg2, Gal E Keren Paz2, Philip H Kim2, Karim A Touijer3, Peter T Scardino3, James A Eastham3. 1. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: skhong@snubh.org. 2. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 3. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.
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.
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.
Authors: Stefan Carlsson; Fredrik Jäderling; Anna Wallerstedt; Tommy Nyberg; Johan Stranne; Thordis Thorsteinsdottir; Sigrid V Carlsson; Anders Bjartell; Jonas Hugosson; Eva Haglind; Gunnar Steineck Journal: BJU Int Date: 2016-03-18 Impact factor: 5.588
Authors: Chang Wook Jeong; Yong Hyun Park; Sung Ii Hwang; Sangchul Lee; Seong Jin Jeong; Sung Kyu Hong; Seok-Soo Byun; Hak Jong Lee; Sang Eun Lee Journal: Prostate Int Date: 2014-12-30