Clinical characteristics and pathologic findings in patients eligible for active surveillance who underwent radical prostatectomy

Abstract

ObjectiveTo analyze clinical characteristics and pathologic findings in patients eligible for active surveillance (AS) who underwent radical prostatectomy (RP). Materials and methodsWe collected data from 495 patients who underwent RP during an 8-year period. We have then selected those who would have been eligible for AS according to 2 different sets of published criteria. Group 1 used broader criteria: clinical stage ≤ T2b, Gleason score of seven or less and PSA ≤ 15 ng/ml. Group 2 used more restrictive criteria: age < 75 years, PSA < 10 ng/ml, clinical stage T1c or T2a, Gleason score of 6 or less, at least 10 biopsies available and a tumor length of less than 3 mm in 2 biopsy cores. ResultsOverall, 207 patients (41.8%) were included in group 1 and 43 (8.7%) in group 2. The median follow-up was 31 (3–108) and 32 (3–84) months in groups 1 and 2, respectively. We recorded 132 cases (63.8%) of pT2c in group 1 and 31 in group 2 (72.1%). Extracapsular extension was noted in 37 (17.9%) and 2 (4.7%) specimens from groups 1 and 2, respectively. In groups 1 and 2, a biochemical failure occurred in 47 patients (22.7%) and 6 (14%), respectively. The Gleason score at biopsy was underestimated in 54 (26%) and 9 (21%) of patients in groups 1 and 2, respectively. ConclusionOverall, 21% to 26% of patients eligible for AS had upgraded Gleason scores at prostatectomy and actually had a more significant disease with a potentially aggressive behavior. Therefore, based on criteria, certain tumors currently selected for AS may be significant and may require radical treatment.