Pathological Outcomes Following Radical Prostatectomy for Low-Risk Prostate Cancer

Area of Science:

• Urology and Oncology
• Medical Imaging in Cancer Diagnosis

Background:

• Growing consensus favors conservative management (active surveillance or watchful waiting) for low-risk prostate cancer (LRPC).
• Advanced imaging, including prostate MRI and PSMA PET/CT, aids in detecting clinically significant prostate cancer (PC) missed by initial biopsies.
• Radical prostatectomy (RP) for LRPC is a performance metric, yet pathological upgrade rates in this group undergoing surgery are anticipated.

Purpose of the Study:

• To evaluate the final pathological outcomes in men with LRPC who underwent radical prostatectomy (RP).
• To identify factors influencing the decision to proceed with RP for LRPC in contemporary practice.

Main Methods:

• Analysis of New South Wales Prostate Cancer Outcomes Registry (NSW-PCOR) Quality Reports from inception.
• Identification of 10 patients who underwent RP for LRPC.
• Extraction of data including biopsy and RP histopathology, and indications for RP from clinical records. Clinically significant PC defined as Gleason score ≤3 + 4 or adverse features.

Main Results:

• Seven out of 10 men (70%) had clinically significant PC confirmed by RP histopathology.
• Preoperative imaging (prostate MRI or PSMA PET/CT) suggested a mismatch with low-grade biopsy pathology in eight men; seven of these had clinically significant PC on RP.
• Other indications for RP included patient anxiety and young age at diagnosis.

Conclusions:

• In this cohort, advanced imaging correctly predicted clinically significant disease in most men undergoing RP for LRPC, except in one case where imaging prompted intervention.
• Reliance on imaging alone to predict occult clinically significant PC requires caution.
• The appropriateness of assigning conservative management solely based on PC risk stratification warrants careful consideration.