title: Candidacy for active surveillance may be associated with improved functional outcomes after prostatectomy.
abstract: OBJECTIVE
  In an effort to curb overtreatment, active surveillance (AS) has grown in popularity as an option for men with low-risk prostate cancer. We evaluated the histopathologic and functional outcomes of patients who qualified for AS, but opted for robotic-assisted laparoscopic prostatectomy (RALP), and compared them to non-AS candidates.
  
  
  METHODS
  An institutional database of 1,477 RALP performed by a single surgeon was queried for AS candidates, defined as PSA <10 ng/mL, biopsy Gleason score ≤6 with a minimum of 10 biopsy cores, <3 positive cores with <50% tumor volume in a single core and clinical stage ≤T2a.
  
  
  RESULTS
  Of the 352 patients who would have qualified for AS, 159 (45%) were upgraded: 143 (41%) to Gl 3 + 4, 16 (4.5%) to 4 + 3, zero to Gleason 8 or higher. Seventeen (4.8%) patients were upstaged to pT3. AS candidates were younger and had more favorable tumor characteristics, but similar preoperative functional status. Bilateral nerve sparing was performed on 96% of AS candidates vs. 86% of non-AS candidates (P < 0.001). After 12 months of follow-up in patients who received bilateral nerve sparing, continence was higher in the AS cohort (98% vs. 92%, P < 0.001) but potency was equivalent (87% in each, P = 0.89). On multivariable analysis, candidacy for AS was independently associated with improved continence, but not potency.
  
  
  CONCLUSIONS
  In addition to having the expected favorable histopathologic features, AS candidates who desire definitive therapy have a high likelihood of achieving excellent functional outcomes, perhaps superior to non-AS candidates, following RALP.
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY 10022, USA. hugh.lavery@mountsinai.org
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Lavery
authors.forename: Adam W
authors.initials: AW
authors.lastname: Levinson
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Brajtbord
authors.forename: David B
authors.initials: DB
authors.lastname: Samadi
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D012371:Robotics; D057832:Watchful Waiting