Pathologic outcomes of candidates for active surveillance undergoing radical prostatectomy

To examine the pathologic findings and biochemical recurrence rates for a consecutive cohort of candidates for active surveillance who underwent radical prostatectomy. The role of active surveillance for the treatment of low-risk prostate cancer is highly controversial.

Between October 2000 and February 2008, a single surgeon performed 1565 open radical retropubic prostatectomies for clinically localized prostate cancer. Cases were selected for extraction if they fulfilled 1 of 2 published criteria for active surveillance in our prospective longitudinal outcomes database. A retrospective review of the prospectively collected database was executed to elucidate the outcomes of candidates for active surveillance who underwent radical retropubic prostatectomy. Gleason score, pathologic stage, and surgical margins were prospectively captured in our database. The 5-year, biochemical-free survival rates were estimated using Kaplan-Meier analysis plots.

Overall, 45.9%-47.2% of cases were pathologically upgraded to a Gleason score ≥ 7. Moreover, 12.3%-13.1% of cases were found to have a primary Gleason pattern of 4 or 5. Extracapsular extension (pT3a disease) was observed in 7.8%-10.9% of cases. A total of 28.8%-32.2% of cases had an estimated percentage of cancer volume in the surgical specimen exceeding 20%. The 5-year biochemical-free survival was estimated to be 83.2%-92.9%.

Our pathologic findings and risk of biochemical recurrence after open radical prostatectomy questions the wisdom of active surveillance in men with low-risk disease who have "long" life expectancies.