title: Pathological findings at radical prostatectomy in patients initially managed by active surveillance: a comparative analysis.
abstract: BACKGROUND
  The purpose of our analysis was to determine if delays in treatment caused by active surveillance result in significant pathological changes when patients no longer meet the criteria on repeat biopsy and to study whether or not these changes may affect treatment outcomes.
  
  
  METHODS
  Out of 207 men who were on active surveillance, 47 (23%) no longer met the criteria after one of the repeat biopsies. Twenty-two underwent radical prostatectomy at our institution and formed the main group (Group 1) of this study. One hundred sixty-four patients met the criteria for active surveillance but underwent immediate surgery. Of these patients, we selected 38 (23%) with the lowest predicted biochemical recurrence-free survival. These patients formed the comparison group (Group 2). Pathological features as well as postoperative biochemical outcomes were compared between the groups.
  
  
  RESULTS
  Seven patients (32%) in Group 1 and four (11%) in Group 2 have predominantly high-grade cancer (i.e., ≥4/5 + 3) at pathology. The visually estimated percent of carcinoma was also higher in patients initially managed by active surveillance (median 12.5 vs. 5.0 in Groups 1 and 2, respectively, P = 0.009). Other pathological characteristics were similar in both groups. With limited duration of follow-up, postoperative biochemical recurrence-free survival did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Our study has demonstrated that both tumor grade and volume may increase during active surveillance. However, the clinical significance of these changes with respect to the outcomes of delayed treatment remains to be established.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida 33101, USA. viremashvili@med.miami.edu
authors.forename: Viacheslav
authors.initials: V
authors.lastname: Iremashvili
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Rosenberg
authors.forename: Kristell
authors.initials: K
authors.lastname: Acosta
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen