PD03-06 RADICAL PROSTATECTOMY FOLLOWING ACTIVE SURVEILLANCE IS ASSOCIATED WITH INCREASED RATES OF UNFAVOURABLE PATHOLOGY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2016PD03-06 RADICAL PROSTATECTOMY FOLLOWING ACTIVE SURVEILLANCE IS ASSOCIATED WITH INCREASED RATES OF UNFAVOURABLE PATHOLOGY Richard Savdie, Robert Bell, Jonathan Anning, Alan So, Martin Gleave, Peter Black, and Larry Goldenberg Richard SavdieRichard Savdie More articles by this author , Robert BellRobert Bell More articles by this author , Jonathan AnningJonathan Anning More articles by this author , Alan SoAlan So More articles by this author , Martin GleaveMartin Gleave More articles by this author , Peter BlackPeter Black More articles by this author , and Larry GoldenbergLarry Goldenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2094AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our centre has offered AS to men with very low to low-tier intermediate risk PCa based on patient and physician accepted balance of competing risks. We aimed to analyse the rates of unfavourable pathology in those undergoing radical prostatectomy (RP) following AS and compare these with a contemporary immediate RP group. METHODS Patients were stratified into very low risk (Epstein), low and intermediate NCCN risk groups. Rates of unfavourable pathology (predominant Gleason pattern 4 or ≥pT3 disease) and PSA failure following radical prostatectomy were analysed. A 2:1 propensity score matched analysis was performed using age, pre-treatment PSA, biopsy Gleason score and clinical T stage with a cohort of immediate RP patients from the same time period. RESULTS 651 men had AS (including 144 Intermediate Risk) with a median follow-up of 4.5 years (range 0.6-19.1). 203 patients had radical prostatectomy after AS (AS+RP) with an overall rate of unfavourable pathology of 34.9%. 195 AS+RP were matched to 390 immediate RP (IRP) with excellent correlation between covariates. The median time to surgery was 1.59 years for the AS+RP group vs 0.3 years for the IRP group ( p<0.001). There were slightly higher rates of EPE in AS+RP vs IRP group but this was not statistically significant (20% v 17%, p=0.5). Predominant Gleason pattern 4 was seen in significantly more men who had delayed RP compared to their matched counterparts (24.6% vs 12%, p<0.001). There was no difference in unfavourable pathology in the very low risk AS+RP vs IRP group (p=0.17). Despite differences in unfavourable pathology, there was no difference in the PSA failure free survival between the two groups at 3 years (Log Rank, p=0.47). CONCLUSIONS Active surveillance carries an increased risk of unfavourable pathology at the time of delayed RP in low and intermediate but not very low risk groups. Early data suggests that PSA recurrence rates are similar following RP despite delay in treatment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e58 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Richard Savdie More articles by this author Robert Bell More articles by this author Jonathan Anning More articles by this author Alan So More articles by this author Martin Gleave More articles by this author Peter Black More articles by this author Larry Goldenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...