Deferred radical prostatectomy in patients who initially elected for active surveillance: a multi-institutional, prospective, observational cohort of the PRIAS-JAPAN study.

This study aimed to evaluate the pathological findings and oncological outcomes of deferred radical prostatectomy in patients who initially elected for active surveillance in a Japanese cohort.

We retrospectively analyzed data collected from a multi-institutional prospective observational cohort of the Prostate Cancer Research International: Active Surveillance-JAPAN study between January 2010 and September 2020. Triggers for radical prostatectomy were disease progression based on pathological findings of repeat biopsy and patients' request. The primary end point was evaluation of prostate-specific antigen recurrence-free survival. Secondary end points were overall survival and comparison of pathological and oncological outcomes between patients stratified into immediate or late radical prostatectomy group by time to radical prostatectomy.

Overall, 162 patients (15.7%) with prostate cancer underwent initial active surveillance followed by radical prostatectomy. The median time to radical prostatectomy was 18 months (interquartile range 14-43.3), and the median postoperative follow-up was 32 months (interquartile range 14-57.5). Prostate-specific antigen recurrence was observed in eight patients (4.9%). The 3-year prostate-specific antigen recurrence-free survival rate was 96.9%. The 5-year overall survival rate was 100%; however, one patient died of another cause. There were no significant differences in pathological findings between immediate and late radical prostatectomy groups. No significant difference in prostate-specific antigen recurrence-free survival was found between the two groups (log-rank p = 0.34).

Radical prostatectomy after active surveillance, as an initial treatment option, does not lead to loss of curative chances in Japanese patients with early-stage prostate cancer in the short follow-up period.

International journal of clinical oncology. 2021 Oct 02 [Epub ahead of print]

Yoichiro Tohi, Takuma Kato, Masaki Nakamura, Ryuji Matsumoto, Hiroshi Sasaki, Koji Mitsuzuka, Junichi Inokuchi, Katsuyoshi Hashine, Akira Yokomizo, Hirohito Naito, Isao Hara, Norihiko Kawamura, Masaharu Inoue, Hiroshi Fukuhara, Satoru Maruyama, Shinichi Sakamoto, Toshihiro Saito, Shin Egawa, Yoshiyuki Kakehi, Mikio Sugimoto

Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. ., Department of Urology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan., Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Department of Renal and Genito-Urinary Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Tohoku University Graduate School of Medicine, Miyagi, Japan., Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Department of Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan., Division of Urology, Harasanshin Hospital, Fukuoka, Japan., Department of Urology, Kurashiki Central Hospital, Okayama, Japan., Department of Urology, Wakayama Medical University, Wakayama, Japan., Department of Urology, Osaka International Cancer Institute, Osaka, Japan., Department of Urology, Saitama Cancer Center, Saitama, Japan., Department of Urology, Kyorin University School of Medicine, Tokyo, Japan., Department of Urology, Hokkaido Cancer Center, Hokkaido, Japan., Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan., Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.

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