Department of Urology, The Mount Sinai Medical Center, New York, NY 10022, USA.
In an effort to curb overtreatment, active surveillance (AS) has grown in popularity as an option for men with low-risk prostate cancer. We evaluated the histopathologic and functional outcomes of patients who qualified for AS, but opted for robotic-assisted laparoscopic prostatectomy (RALP), and compared them to non-AS candidates.
An institutional database of 1,477 RALP performed by a single surgeon was queried for AS candidates, defined as PSA < 10 ng/mL, biopsy Gleason score ≤ 6 with a minimum of 10 biopsy cores, < 3 positive cores with < 50% tumor volume in a single core and clinical stage ≤ T2a.
Of the 352 patients who would have qualified for AS, 159 (45%) were upgraded: 143 (41%) to Gl 3 + 4, 16 (4.5%) to 4 + 3, zero to Gleason 8 or higher. Seventeen (4.8%) patients were upstaged to pT3. AS candidates were younger and had more favorable tumor characteristics, but similar preoperative functional status. Bilateral nerve sparing was performed on 96% of AS candidates vs. 86% of non-AS candidates (P < 0.001). After 12 months of follow-up in patients who received bilateral nerve sparing, continence was higher in the AS cohort (98% vs. 92%, P < 0.001) but potency was equivalent (87% in each, P = 0.89). On multivariable analysis, candidacy for AS was independently associated with improved continence, but not potency.
In addition to having the expected favorable histopathologic features, AS candidates who desire definitive therapy have a high likelihood of achieving excellent functional outcomes, perhaps superior to non-AS candidates, following RALP.
Written by:
Lavery HJ, Levinson AW, Brajtbord JS, Samadi DB. Are you the author?
Reference: Urol Oncol. 2011 Jul 25. Epub ahead of print.
doi: 10.1016/j.urolonc.2010.11.013
PubMed Abstract
PMID: 21795076
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