title: Definitive pathology at radical prostatectomy is commonly favorable in men following initial active surveillance.
abstract: BACKGROUND
  Limited data are currently available regarding the outcomes of radical prostatectomy (RP) in men with low-risk prostate cancer who were initially managed by active surveillance (AS).
  
  
  OBJECTIVE
  To evaluate the pathologic outcomes of patients who underwent RP following initial AS.
  
  
  METHODS
  We analyzed the records of 67 patients who underwent RP following initial AS begun between 1993 and 2011. All patients underwent confirmatory biopsy to reassess eligibility for AS. RP was recommended for disease progression suggested by follow-up biopsies or imaging.
  
  
  METHODS
  Unfavorable disease was defined as having at least one of the following pathologic findings: Gleason score (GS) ≥4+3, extracapsular extension of tumor, seminal vesicle invasion, or lymph node involvement. A descriptive analysis was performed to assess pathologic features.
  
  
  CONCLUSIONS
  Median time from confirmatory biopsy to RP was 1.7 yr (range: 0.3-7.8). Reasons for discontinuing AS to undergo RP included evidence of increased tumor volume or grade on follow-up biopsy, patient preference/anxiety, and findings on follow-up imaging in 46 patients (68.7%), 17 patients (25.3%), and 4 patients (6.0%), respectively. Pathologic analyses revealed organ-confined disease in 55 patients (82.1%), and GS was ≥4+3 in 9 (13.4%). Positive nodes were observed in three patients (4.4%) and positive surgical margin in two (3.0%). Overall, 19 patients (28.4%) had unfavorable disease. Of the biopsy criteria for triggering RP, Gleason patterns >3 were the most frequently associated with unfavorable disease (43.3%). One patient (1.5%) experienced biochemical recurrence during postoperative follow-up (median: 3.2 yr). Our study may be limited by its retrospective and single-institution nature.
  
  
  CONCLUSIONS
  Most patients who started initially on AS after undergoing confirmatory biopsy showed pathologically organ-confined disease with a low GS at RP. Such findings provide further evidence that, overall, AS is a safe treatment approach.
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: skhong@snubh.org.
authors: Sung Kyu
authors: SK
authors: Hong
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Itay A
authors: IA
authors: Sternberg
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Gal E
authors: GE
authors: Keren Paz
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Philip H
authors: PH
authors: Kim
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.
authors: Karim A
authors: KA
authors: Touijer
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.
authors: Peter T
authors: PT
authors: Scardino
authors: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.
authors: James A
authors: JA
authors: Eastham
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D057240:Patient Preference; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D012669:Seminal Vesicles / Q000473:pathology; D047368:Tumor Burden; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
keywords: Active surveillance; Prostate; Prostatectomy; Prostatic neoplasms