674 CLINICOPATHOLOGIC CORRELATION AND BIOCHEMICAL RECURRENCE-FREE SURVIVAL FOR INTERMEDIATE RISK PROSTATE CANCER: IMPLICATIONS FOR ACTIVE SURVEILLANCE

Abstract

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is an increasingly popular treatment for patients with low risk prostate cancer, but there is little data on whether AS is appropriate for patients with Gleason 3 4 disease who otherwise meet AS criteria. We therefore evaluated the clinicopathologic findings for such intermediate risk patients undergoing radical prostatectomy. METHODS: Patients with Gleason 3 4 on biopsy who underwent radical prostatectomy from 2001 through 2011 were identified from a tumor bank database. Patients with incomplete biopsy data were excluded from analysis. Candidates for active surveillance were defined as those with 3 cores with cancer, 50% of cancer in any core, and PSA 10 ng/ml (Berglund et al, J Urol, 2008). Biochemical recurrence was defined as a post-operative PSA of 0.2 ng/ml or greater. RESULTS: A total of 108 patients were candidates for AS. Mean age, pre-operative PSA, and prostate weight were 61.1 6.7 years, 5.0 2.0 ng/ml, and 50.3 22.5 grams. Clinical stage was cT1c in 92 (86.0%) patients and cT2 in 15 (14.0%) patients. Median number of cores at biopsy was 12 (range 6-24). Prostatectomy Gleason score was 3 3 in 27 (25.0%) patients, 3 4 in 68 (63.0%) patients, 4 3 in 10 (9.3%) patients, and 8-10 in 3 (2.8%) patients. Gleason score upgrading was observed in 13 (12.0%) patients. Adverse pathologic findings included positive surgical margins in 11 (10.2%) patients, extracapsular extension in 11 (10.2%) patients, and seminal vesicle invasion in 3 (2.8%) patients. A total of 20 (18.5%) distinct patients had either pT3 disease or positive surgical margins. On logistic regression, number of positive cores and highest percentage of core with cancer were not associated with adverse pathologic findings at prostatectomy. Of 104 patients with follow-up data, 7 (6.7%) patients had biochemical failure at a median follow-up of 30.4 months (range 1.7 u 119.5 months). The 5-year estimated biochemical recurrence-free survival was 86.8%. CONCLUSIONS: There is a significant rate of adverse pathologic findings and short-term biochemical recurrence for intermediate risk AS candidates undergoing prostatectomy. Traditional predictors of risk were not associated with adverse pathologic features. These results have implications for AS protocols.