Long-term outcomes after deferred radical prostatectomy in men initially managed by active surveillance

To determine the long-term outcomes after deferred radical prostatectomy.

The study population consisted of all men with screening-detected prostate cancer who underwent deferred radical prostatectomy (n=132; 1 Jan 1995-31 Dec 2014) after active surveillance in the Göteborg Randomized, Population-based Prostate Cancer Screening Trial. The last date of follow-up was 15 May 2017. Follow-up during active surveillance was performed with prostate-specific antigen (PSA)-tests every 3-6 months and repeat biopsies every 2-4 years. Triggers for radical prostatectomy were disease progression (PSA, grade, and/or stage) or patient request. The outcomes included adverse pathology at radical prostatectomy (Gleason score>3+4, extra-prostatic extension, positive margins, seminal vesicle invasion, and/or N+), whether or not the index tumor at radical prostatectomy was identified at biopsy, and PSA relapse-free survival. The Kaplan-Meier analysis was used.

The median time from diagnosis to surgery was 1.9 years (IQR 1.2-4.2 years) and the median follow-up time after surgery was 10.9 years (IQR 7.5-14.5 years). In total, 52 men (39%) experienced at least one feature of unfavorable pathology at radical prostatectomy. The 10-year PSA relapse-free survival was 79.5%. The index tumor was not identified in the diagnostic biopsy in 29% of the men (38/132) or at the last repeat biopsy that preceded radical prostatectomy in 21% (22/105).

A large proportion of men had unfavorable pathology at deferred radical prostatectomy and the index tumor was frequently not identified. There is a clear need for better risk classification and protocols for determining disease progression during active surveillance.

The Journal of urology. 2018 May 03 [Epub ahead of print]

Rebecka Arnsrud Godtman, Max Schafferer, Carl-Gustaf Pihl, Johan Stranne, Jonas Hugosson

Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: ., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden., Department of Pathology, Institute of Biomedicine, Sahlgrenska Academy at University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden.