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 language | English |
|---|---|
| Pages (from-to) | 195-200 |
| Number of pages | 6 |
| Journal | European Urology |
| Volume | 62 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Aug 2012 |
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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 journal › Article
}
TY - JOUR
T1 - Radical prostatectomy for low-risk prostate cancer following initial active surveillance
T2 - Results from a prospective observational study
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.
PY - 2012/8
Y1 - 2012/8
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.
KW - Active surveillance
KW - Disease progression
KW - Prostatic neoplasms
KW - Radical prostatectomy
KW - Reclassification
KW - Risk
UR - http://www.scopus.com/inward/record.url?scp=84862869430&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862869430&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2012.02.002
DO - 10.1016/j.eururo.2012.02.002
M3 - Article
C2 - 22342775
AN - SCOPUS:84862869430
VL - 62
SP - 195
EP - 200
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 2
ER -