Radical prostatectomy for low-risk prostate cancer following initial active surveillance: Results from a prospective observational study

Meelan Bul, Xiaoye Zhu, Antti Rannikko, Frédéric Staerman, Riccardo Valdagni, Tom Pickles, Chris H. Bangma, Monique J. Roobol

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa). Objective: Evaluate pathology findings after RP in our prospective AS cohort. Design, setting, and participants: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage ≤T2, prostate-specific antigen [PSA] ≤10 ng/ml, PSA density 6 and/or more than two positive cores) or a PSA doubling time ≤3 yr. Measurements: Descriptive statistics were used to report on pathology findings for staging and grading. Results and limitations: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores ≤6, 3 + 4, 4 + 3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score ≥4 + 3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP. Conclusions: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated.

Original languageEnglish
Pages (from-to)195-200
Number of pages6
JournalEuropean Urology
Volume62
Issue number2
DOIs
Publication statusPublished - Aug 2012

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Prostatectomy
Observational Studies
Prostatic Neoplasms
Prospective Studies
Neoplasm Grading
Prostate-Specific Antigen
Pathology
Patient Selection
Anxiety
Biopsy
Research

Keywords

  • Active surveillance
  • Disease progression
  • Prostatic neoplasms
  • Radical prostatectomy
  • Reclassification
  • Risk

ASJC Scopus subject areas

  • Urology

Cite this

Radical prostatectomy for low-risk prostate cancer following initial active surveillance : Results from a prospective observational study. / Bul, Meelan; Zhu, Xiaoye; Rannikko, Antti; Staerman, Frédéric; Valdagni, Riccardo; Pickles, Tom; Bangma, Chris H.; Roobol, Monique J.

In: European Urology, Vol. 62, No. 2, 08.2012, p. 195-200.

Research output: Contribution to journalArticle

Bul, Meelan ; Zhu, Xiaoye ; Rannikko, Antti ; Staerman, Frédéric ; Valdagni, Riccardo ; Pickles, Tom ; Bangma, Chris H. ; Roobol, Monique J. / Radical prostatectomy for low-risk prostate cancer following initial active surveillance : Results from a prospective observational study. In: European Urology. 2012 ; Vol. 62, No. 2. pp. 195-200.
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AU - Bul, Meelan

AU - Zhu, Xiaoye

AU - Rannikko, Antti

AU - Staerman, Frédéric

AU - Valdagni, Riccardo

AU - Pickles, Tom

AU - Bangma, Chris H.

AU - Roobol, Monique J.

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N2 - Background: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa). Objective: Evaluate pathology findings after RP in our prospective AS cohort. Design, setting, and participants: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage ≤T2, prostate-specific antigen [PSA] ≤10 ng/ml, PSA density 6 and/or more than two positive cores) or a PSA doubling time ≤3 yr. Measurements: Descriptive statistics were used to report on pathology findings for staging and grading. Results and limitations: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores ≤6, 3 + 4, 4 + 3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score ≥4 + 3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP. Conclusions: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated.

AB - Background: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa). Objective: Evaluate pathology findings after RP in our prospective AS cohort. Design, setting, and participants: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage ≤T2, prostate-specific antigen [PSA] ≤10 ng/ml, PSA density 6 and/or more than two positive cores) or a PSA doubling time ≤3 yr. Measurements: Descriptive statistics were used to report on pathology findings for staging and grading. Results and limitations: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores ≤6, 3 + 4, 4 + 3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score ≥4 + 3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP. Conclusions: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated.

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KW - Prostatic neoplasms

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