PURPOSE: We assessed oncologic outcomes at surgery in men with low-risk and very low-risk prostate cancer who were candidates for active surveillance.
MATERIALS AND METHODS: In a prospectively-collected institutional database, we identified 7,486 subjects eligible for active surveillance who underwent radical retropubic prostatectomy. Candidates were designated as low-risk (LR; stage T1c/T2a, PSA ≤ 10 ng/ml, and Gleason score ≤ 6) or very low-risk (VLR; stage T1c, PSA density ≤ 0.15, Gleason score ≤ 6, ≤ 2 positive biopsy cores, ≤ 50% cancer involvement per core) based on pre-operative data. Adverse findings were Gleason score upgrade (GS≤ 7) and non organ-confined cancer (NOCC) on surgical pathology. The relative risk (RR) of adverse findings in men with LR and VLR disease were evaluated in a multivariable model using Poisson regression.
RESULTS: 7,333 subjects met criteria for LR disease and 153 had VLR disease. The proportions of LR subjects found to have GS upgrade or non organ-confined cancer (NOCC) on final pathology were 21.8% and 23.1%, respectively. The corresponding values in VLR subjects were 13.1% and 8.5%. After adjusting for age, race, year of surgery, BMI, and PSA at diagnosis, the relative risk of GS upgrade in LR versus VLR disease was 1.89 (95% CI: 1.21-2.95). Relative risk of NOCC was 2.06 (95% CI: 1.19-3.57).
CONCLUSION: Men with very low-risk prostate cancer had a significantly lower risk of adverse findings at surgery compared to those with low-risk disease. These data support the stratification of low risk cancer when selecting and counseling men who may be appropriate for active surveillance.
Written by:
Tosoian JJ, Johnbull E, Trock BJ, Landis P, Epstein JI, Partin AW, Walsh PC, Carter HB. Are you the author?
Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.
Reference: J Urol. 2013 Apr 30. pii: S0022-5347(13)04222-5.
doi: 10.1016/j.juro.2013.04.071
PubMed Abstract
PMID: 23643603
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