Poor association between the progression criteria in active surveillance and subsequent histopathological findings following radical prostatectomy.
OBJECTIVE
The objective of this study was to investigate the association between active surveillance (AS) progression criteria and histopathology features in subsequent radical prostatectomy (RP) specimens.


METHODS
Of 229 patients managed on AS, 80 patients underwent RP, of whom 68 met at least one of the following three progression criteria: progression on rebiopsy, short prostate-specific antigen (PSA) doubling time (PSAdt) and increase clinical tumour category (cT). Patients revealing histopathological features in the RP specimens involving GS ≥ 7 (3 + 4) were considered to have achieved a potential survival gain from the procedure (timely RP). The association between the progression criteria and timely RP was analysed using univariate logistic regression analyses.


RESULTS
Of the 68 patients who met at least one of the progression criteria, 66% had timely RP features. Progression on rebiopsy was significantly associated with timely RP [odds ratio (OR) = 5.00, 95% confidence interval (CI) 1.51-16.51]. Although not statistically significant, progression defined by PSAdt was negatively associated with timely RP (OR = 0.36, 95% CI 0.13-1.00). Increase in cT showed no association with timely RP (OR = 1.17, 95% CI 0.35-3.87).


CONCLUSIONS
A poor association was found between the progression criteria employed in the AS programme and histopathology features after subsequent RP. Only progression on rebiopsy was significantly associated with final histopathology.
a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Copenhagen, Denmark.
Frederik Birkebæk
FB
Thomsen
a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Copenhagen, Denmark.
Kasper Drimer
KD
Berg
a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Copenhagen, Denmark.
Peter
P
Iversen
a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Copenhagen, Denmark.
Klaus
K
Brasso
D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D057832:Watchful Waiting
D017430:Prostate-Specific Antigen
Active surveillance; progression criteria; prostate cancer; radical prostatectomy