1062 PATHOLOGIC STAGE AND IMPLICATIONS FOR CURE IN ACTIVE SURVEILLANCE PATIENTS WHO UNDERGO RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 20101062 PATHOLOGIC STAGE AND IMPLICATIONS FOR CURE IN ACTIVE SURVEILLANCE PATIENTS WHO UNDERGO RADICAL PROSTATECTOMY Bruce J. Trock, Zhaoyong Feng, Patricia Landis, Jonathan I. Epstein, and H. Ballentine Carter Bruce J. TrockBruce J. Trock More articles by this author , Zhaoyong FengZhaoyong Feng More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan I. EpsteinJonathan I. Epstein More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2186AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) with delayed intervention is an option for men thought to harbor low grade, low volume prostate cancer. The pathological outcomes of men who undergo delayed surgical intervention after being managed in a surveillance program have not been evaluated in large numbers of men, particularly in men followed according to a stringent surveillance protocol. We compared pathological outcomes of men in an AS cohort who underwent delayed surgical intervention to those of a group of men eligible for AS but who instead chose immediate radical prostatectomy. METHODS Since 1995, 749 men have been enrolled in the AS program at Johns Hopkins; 107 (14%) underwent radical prostatectomy (RP) at a median of 2 (0.5-8) years after diagnosis. The trigger for RP was usually an increase in Gleason grade or amount of tumor in a follow-up biopsy. They were matched to 321 men who met eligibility criteria for AS (biopsy Gleason grade 3, ≤2 cores involved, ≤50% involvement of any core with cancer, and PSA density<0.15), but who chose to have immediate RP; the 2 groups were compared for pathology outcomes at surgery. 10 year biochemical recurrence-free survival (BRFS) predicted by nomogram to be <75% was used as a surrogate for more aggressive tumor. RESULTS At surgery, men initially managed with AS were significantly more likely to have non-organ-confined tumors (p=0.009), Gleason score ≥4+3 (p=0.0002), and predicted 10 year BRFS <75% (p=0.0003) when compared to matched men who underwent surgery immediately. However, when comparing the subgroup of AS patients upgraded at follow-up biopsy to Gleason ≥7 vs. the subgroup of immediate RP patients upgraded at surgery to Gleason ≥7, the surgical pathology outcomes were similar (Table). CONCLUSIONS Men who undergo delayed RP after initial management with AS have similar pathological outcomes to those men who are candidates for AS but undergo immediate surgery when matched for Gleason score. These data suggest that active surveillance is associated with a low risk of stage progression. Longer follow-up is needed to determine the association with recurrence or prostate cancer mortality in this generally older cohort. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e413-e414 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruce J. Trock More articles by this author Zhaoyong Feng More articles by this author Patricia Landis More articles by this author Jonathan I. Epstein More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...