What is the "true" incidence of active surveillance and brachytherapy candidates in men undergoing robot-assisted radical prostatectomy?
OBJECTIVE
To correlate clinical low-risk prostate cancers with pathologic outcomes in men who are considered for active surveillance (AS), interstitial radiation therapy, or radical prostatectomy (RP).


METHODS
Clinical and pathologic data of 76 consecutive patients who underwent RP by a single surgeon between October 2001 and July 2008 were reviewed. The retrospective review identified men with clinical low-risk disease--defined as a prostate-specific antigen (PSA) level <10 ng/mL, no Gleason pattern >3, no >2 cores positive, and no core >50%--who would also have been considered for AS and/or brachytherapy based on these features. Pathologic specimens were examined for Gleason primary, secondary, and tertiary patterns, perineural invasion, capsular involvement, margins, nodal disease, and seminal vesicle involvement.


RESULTS
Of the patients who underwent RP, 42/76 (55%) had low-risk clinical staging; 8/76 (19%) had low-risk features on final pathologic staging. Fifty-four of 76 (71%) were pT2c; 10% were pT3. Gleason 6 was seen in 41/76 (53%) of RP specimens; Gleason 7 and 8 in 41% and 4%, respectively. Favorable brachytherapy parameters were identified in 63% of those who underwent surgery, but 39 of 48 (81%) would have been inappropriately selected based on features of the pathologic specimen.


CONCLUSIONS
Clinical staging based on PSA level and biopsy findings correlates poorly with pathologic outcome when stratifying for low-risk features in men who may be candidates for brachytherapy and/or AS.
Bresee
James
J
Sol and Margaret Berger Department of Urology, Beth Israel Medical Center, New York, New York 10016, USA.
Spuma
Patricia
P
Lipsky
Michael
M
Phillips
John L
JL
Dinlenc
Caner Z
CZ
Tareen
Basir
B
D001918:Brachytherapy; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics