Commentary on Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically: Louie-Johnsun M, Neill M, Treurnicht K, Jarmulowicz M, Eden C, Department of Laparoscopic Urology, Royal Surrey County Hospital, Guildford, Surrey and The Hampshire Clinic, Basingstoke, Hampshire, UK

Abstract

To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series. From 1,080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level > 10 ng/ml, clinical stage ≤ T2a, and biopsy Gleason score ≤ 6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of “insignificant” disease were assessed. The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1–9) ng/ml; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score ≥ 7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%), and biochemical failure occurred in 6 patients (1.1%) with a median follow-up of 28 months. In this contemporary UK cohort of patients with apparently low- or favorable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harboring more significant disease.