1062 PATHOLOGIC STAGE AND IMPLICATIONS FOR CURE IN ACTIVE SURVEILLANCE PATIENTS WHO UNDERGO RADICAL PROSTATECTOMY

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

Active surveillance (AS) with delayed intervention is an option for men thought to harbor low grade, low volume prostate cancer. The pathological outcomes of men who undergo delayed surgical intervention after being managed in a surveillance program have not been evaluated in large numbers of men, particularly in men followed according to a stringent surveillance protocol. We compared pathological outcomes of men in an AS cohort who underwent delayed surgical intervention to those of a group of men eligible for AS but who instead chose immediate radical prostatectomy.

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METHODS 

Since 1995, 749 men have been enrolled in the AS program at Johns Hopkins; 107 (14%) underwent radical prostatectomy (RP) at a median of 2 (0.5-8) years after diagnosis. The trigger for RP was usually an increase in Gleason grade or amount of tumor in a follow-up biopsy. They were matched to 321 men who met eligibility criteria for AS (biopsy Gleason grade 3, ≤2 cores involved, ≤50% involvement of any core with cancer, and PSA density<0.15), but who chose to have immediate RP; the 2 groups were compared for pathology outcomes at surgery. 10 year biochemical recurrence-free survival (BRFS) predicted by nomogram to be <75% was used as a surrogate for more aggressive tumor.

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RESULTS 

At surgery, men initially managed with AS were significantly more likely to have non-organ-confined tumors (p=0.009), Gleason score ≥4+3 (p=0.0002), and predicted 10 year BRFS <75% (p=0.0003) when compared to matched men who underwent surgery immediately. However, when comparing the subgroup of AS patients upgraded at follow-up biopsy to Gleason ≥7 vs. the subgroup of immediate RP patients upgraded at surgery to Gleason ≥7, the surgical pathology outcomes were similar (Table).

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CONCLUSIONS 

Men who undergo delayed RP after initial management with AS have similar pathological outcomes to those men who are candidates for AS but undergo immediate surgery when matched for Gleason score. These data suggest that active surveillance is associated with a low risk of stage progression. Longer follow-up is needed to determine the association with recurrence or prostate cancer mortality in this generally older cohort.