1744 PATHOLOGIC UPGRADING IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE IN A VETERANS AFFAIRS POPULATION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 20101744 PATHOLOGIC UPGRADING IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE IN A VETERANS AFFAIRS POPULATION Eugene Lee, Janet Baack, J. Brantley Thrasher, and Jeffrey Holzbeierlein Eugene LeeEugene Lee More articles by this author , Janet BaackJanet Baack More articles by this author , J. Brantley ThrasherJ. Brantley Thrasher More articles by this author , and Jeffrey HolzbeierleinJeffrey Holzbeierlein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1593AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance for prostate cancer is an option which is gaining more favor. This is likely a result of the substantial stage migration with the advent of the PSA. The decision to begin a patient on active surveillance is based on biopsy results and PSA. There are several protocols in existence but most agree that patients qualify with a Gleason Sum of 6, PSA less than 20, and a low volume of cancer in the biopsied specimen. Studies have shown upgrading or upstaging rates on repeat biopsy to be around 27% to 37%. We review our series with the veteran population. METHODS We review our series of patients from the Kansas City Veterans Affairs Medical Center (KCVA) who met the requirements for active surveillance between January 2004 and December 2008. Our criteria for active surveillance included: Gleason sum 6 or less, percent of cancer in the specimen less than 20%, and PSA less than 20 ng/dl. We then identified the patients who underwent immediate prostatectomy. The pathology reports were reviewed for stage, Gleason grade, percent of tissue involved with cancer, margin status, nodal status, and rate of biochemical recurrence. RESULTS 147 patients met the requirements for active surveillance. Among them, 61 patients chose to undergo immediate radical prostatectomy at the KCVA. The average age was 62.1 years, the average PSA was 6.4, and the average percentage of biopsy involved with cancer was 6.5%. All men had a Gleason sum of 6. Upon radical prostatectomy, 59/61 (96.7%) had T2 disease and two patients had T3 disease. 40 of 61 (65.6%) prostatectomy specimens had upgrading of Gleason score including 11 patients (18%) with tertiary Gleason 5 and one with primary Gleason grade 5. 8/61 (13.1%) patients had positive margins. 0/53 patients had positive lymph nodes. 2 patients have had biochemical recurrence on follow-up. CONCLUSIONS Active surveillance has gained much enthusiasm as more men are screen detected and in low risk categories for prostate cancer. Although this method of treatment is appropriate in specific patient populations, we feel that the rate of upgrading and upstaging in our veteran population is alarming. We are currently considering a modification to our active surveillance protocol which may include an immediate repeat prostate biopsy. Kansas City, KS© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e674 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Lee More articles by this author Janet Baack More articles by this author J. Brantley Thrasher More articles by this author Jeffrey Holzbeierlein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...