title: Pathological, oncologic and functional outcomes of radical prostatectomy following active surveillance.
abstract: OBJECTIVE
  We examined prostatectomy pathology, and oncologic and functional outcomes of men progressing from active surveillance to radical prostatectomy.
  
  
  METHODS
  We identified patients on active surveillance treated with radical prostatectomy. We compared patients on active surveillance ultimately treated with radical prostatectomy to age and prostate specific antigen matched men undergoing immediate radical prostatectomy after a diagnosis of low risk disease who were candidates for active surveillance (group 1). We also compared patients on active surveillance with progression to Gleason 7 disease to men treated who had similar de novo disease (group 2) to determine whether patients on active surveillance have potentially adverse outcomes.
  
  
  RESULTS
  Of 289 patients on active surveillance 41 (14.2%) underwent radical prostatectomy after a median of 35.2 months (IQR 22.8-46.6) on active surveillance. Compared to group 1, the radical prostatectomy after active surveillance group had expectedly worse pathological outcomes, whereas the pathological outcomes of patients undergoing radical prostatectomy after active surveillance with progression to Gleason 7 disease were similar to those of group 2. At a median of 3.5 years from radical prostatectomy (IQR 2.6-4.7), biochemical recurrence was low and comparable between the radical prostatectomy after active surveillance group and group 1 (2.6% vs 5.4%, p = 0.47), while erectile function was 29.0% and continence 89.7%, comparable to both groups.
  
  
  CONCLUSIONS
  Radical prostatectomy after a period of active surveillance does not appear to result in adverse pathological outcomes compared to patients with a similar preoperative pathology.
authors: Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Raj
authors: R
authors: Satkunasivam
authors: Girish S
authors: GS
authors: Kulkarni
authors: Alexander R
authors: AR
authors: Zlotta
authors: Robin
authors: R
authors: Kalnin
authors: John
authors: J
authors: Trachtenberg
authors: Neil E
authors: NE
authors: Fleshner
authors: Robert J
authors: RJ
authors: Hamilton
authors: Michael A S
authors: MA
authors: Jewett
authors: Antonio
authors: A
authors: Finelli
mesh_terms: D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen