title: Comparison of Biochemical Recurrence-Free Survival after Radical Prostatectomy Triggered by Grade Reclassification during Active Surveillance and in Men Newly Diagnosed with Similar Grade Disease.
abstract: We compared biochemical recurrence between men on active surveillance who underwent radical prostatectomy triggered by grade reclassification and men diagnosed with similar grade disease treated with immediate radical prostatectomy.
  
  
  
  We retrospectively analyzed the records of men who underwent surgery from 1995 to 2015 at our institution. We identified 4 groups, including 94 and 56 men on active surveillance who underwent radical prostatectomy following reclassification to Gleason 7 (3 + 4) or greater (grade groups 2 or greater) and Gleason 7 (3 + 4) (grade group 2), and 3,504 and 1,979 in the immediate prostatectomy group diagnosed with grade group 2 or greater and 2, respectively. Biochemical recurrence was assessed by Kaplan-Meir analysis and a multivariable Cox model.
  
  
  
  Men on active surveillance had a lower incidence of biochemical recurrence than men in the immediate radical prostatectomy groups for biopsy grade groups 2 or greater and 2 (each p <0.05). One, 5 and 10-year biochemical recurrence-free survival for men in the active surveillance group vs the immediate radical prostatectomy group was 97.9% vs 85.5%, 76.6% vs 65.1% and 69.0% vs 54.2% in biopsy grade groups 2 or greater (p = 0.009) and 96.4% vs 91.2%, 89.6% vs 74.0% and 89.6% vs 63.9%, respectively, in biopsy grade group 2 (p = 0.071). For biopsy grade groups 2 or greater there was no significant difference in the risk of biochemical recurrence between the groups after adjusting for age, biopsy extent of cancer and prostate specific antigen density.
  
  
  
  Patients on active surveillance reclassified to grade groups 2 or greater are at no greater risk for treatment failure than men newly diagnosed with similar grades.
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Clarissa P
authors.initials: CP
authors.lastname: Diniz
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Landis
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: mmamawa1@jhmi.edu.
authors.forename: Mufaddal
authors.initials: M
authors.lastname: Mamawala
mesh_terms: D001706:Biopsy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
keywords: neoplasm grading; prostate-specific antigen; prostatectomy; prostatic neoplasms; watchful waiting