Clinical characteristics and pathologic findings in patients eligible for active surveillance who underwent radical prostatectomy.
OBJECTIVE
To analyze clinical characteristics and pathologic findings in patients eligible for active surveillance (AS) who underwent radical prostatectomy (RP).


METHODS
We 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.


RESULTS
Overall, 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.


CONCLUSIONS
Overall, 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.
Drouin
Sarah J
SJ
Department of Urology of GHU EST, Assistance-Publique Hôpitaux de Paris, Paris, France.
Comperat
Eva
E
Cussenot
Olivier
O
Bitker
Marc-Olivier
MO
Haertig
Alain
A
Rouprêt
Morgan
M
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011467:Prostate / Q000473:pathology / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D018571:Sentinel Surveillance
D017430:Prostate-Specific Antigen