Predictors of Adverse Pathology in Men Undergoing Radical Prostatectomy Following Initial Active Surveillance.
OBJECTIVE
To report pathologic outcomes and predictors of adverse pathology in men undergoing radical prostatectomy (RP) after an initial period of active surveillance (AS).


METHODS
We studied pathologic outcomes in men who underwent RP after some time on AS. Pathologic outcomes were compared between men with and without evidence of disease reclassification on AS. Rates of adverse pathology (defined as pathologic stage ≥ pT3a, RP Gleason ≥ 4+3, or lymph node involvement) were determined and were compared depending on the variable that defined disease reclassification.


RESULTS
Of 1086 men enrolled in AS, 130 (12.0%) underwent RP after a median time of 1.96 years (range, 0.55-12.26 years) on AS. Ninety-seven (74.6%) of these men had evidence of disease reclassification on AS. Rates of adverse pathology were greater in men with evidence of reclassification compared to those without (P = .05). Among men with disease reclassification, rates of adverse pathology ranged from 23.8% to 44.7% depending on the variable used to define reclassification. Longer time on AS was not associated with adverse pathology (P = .68).


CONCLUSIONS
Adverse pathology after RP is more common in men with evidence of disease reclassification on AS compared to those undergoing RP for other reasons. However, we identified varying outcomes among these patients depending on the criterion that defined reclassification. These data may enable identification of men who can safely continue on AS despite evidence of disease reclassification.
Department of Urology, Temple University School of Medicine, Philadelphia, PA. Electronic address: adam.reese@tuhs.temple.edu.
Adam C
AC
Reese
The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
Zhaoyong
Z
Feng
The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
Patricia
P
Landis
The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
Bruce J
BJ
Trock
The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
Jonathan I
JI
Epstein
The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD.
H Ballentine
HB
Carter
D000046:Academic Medical Centers; D000368:Aged; D015142:Baltimore; D001707:Biopsy, Needle; D018450:Disease Progression; D006801:Humans; D007150:Immunohistochemistry; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods*
D017430:Prostate-Specific Antigen