As enrollment in active surveillance (AS) expands, it is increasingly important to assess potential risks of deferred treatment. We evaluated the risk of prostate specific antigen (PSA) recurrence in a large cohort of men undergoing radical prostatectomy (RP) after initial AS.
The study included men undergoing RP after a period of AS with Gleason grade group (GG) 1 or 2 at diagnosis, clinical ≤T2, and a low or intermediate risk disease at diagnosis. Men were stratified by a composite variable of GG and volume of high-grade cores at diagnosis. Pathological characteristics and recurrence after RP were evaluated.
Of 1,916 men enrolled in AS between 1994 and 2017, 448 (23.4%) underwent deferred RP. Median time to RP was 27 months (IQR 15.5-46.5). At diagnosis, 388 men (86.6%) had GG1 disease, 31 men (6.9%) had GG2 disease with one high-grade core, and 29 men (6.5%) had GG2 with ≥2 high-grade cores. GG2 with ≥2 high-grade cores at diagnosis was associated with an increased risk of recurrence when compared to GG1 disease (HR 3.29, 95%CI 1.49 to 7.26, p<0.01), while GG2 with one high-grade core did not significantly differ from GG1.
Our results support the careful use of AS in men with GG2 and one high-grade core at diagnosis. Men with ≥2 high-grade (GG≥2) cores at diagnosis may benefit from immediate treatment.
The Journal of urology. 2019 Apr 08 [Epub ahead of print]
Ashwin S Balakrishnan, Janet E Cowan, Matthew R Cooperberg, Katsuto Shinohara, Hao G Nguyen, Peter R Carroll
Department of Urology and the UCSF - Helen Diller Family Comprehensive Cancer Center, University of California San Francisco , San Francisco , CA.