Pathological Outcomes of Men Eligible for Active Surveillance After Undergoing Radical Prostatectomy: Are Results Predictable?

The increasing incidence of low-risk prostate cancer, associated with a downward migration in clinical staging and grading leads to a critical reflection of 612 patients with prostate cancer and their potential eligibility to participate in an active surveillance program. Introduction: To analyze pathological results in patients with prostate cancer eligible for active surveillance (AS) after radical prostatectomy and available prediction systems. Methods: A retrospective analysis was performed of 612 patients who underwent radical prostatectomy during a 14-year period. Subsequently, we selected those patients who would have been eligible for AS according to 2 different published criteria. Group AS-A matched the following criteria: <= T2a; Gleason Score <= 6; and prostate-specific antigen <10 ng/mL, while group AS-B applied to different criteria: <= T2a; Gleason Score <7; and prostate-specific antigen <= 15 ng/mL. Pathological outcomes were compared with results of the 2001 Partin tables. Results: Altogether, 125 (20.4%) patients were included in group AS-A and 159 (25.9%) in group AS-B. We detected 32 cases of >pT2c (25.6%) for group AS-A and 47 cases (29.6%) for AS-B, respectively. Gleason score upgrading was recorded in 34.4% (AS-A) and 38.3% (AS-B). Results of the Partin tables showed good discrimination among patients at risk for positive lymph nodes but limited discrimination for organ-confined disease, seminal vesicle. Conclusions: Overall >25% of patients eligible for AS showed either upstaging or Gleason score upgrading, which could not be measured with the examined predictive tools. Patients should be informed about the risks of inaccurate preoperative diagnostic. (C) 2012 Elsevier Inc. All rights reserved.