Little is known about the consequences of delaying radical prostatectomy (RP) after Active Surveillance (AS) according to stringent or wider entry criteria. We investigated the association between inclusion criteria and rates, and timing of adverse pathological findings (APFs) among patients in GAP3 cohorts.
APFs (GG ≥ 3, pT ≥ 3, pN > 0 and positive surgical margins [R1]) were accounted for in very low-risk (VLR: grade group [GG] 1, cT1, positive cores < 3, PSA < 10 ng/mL, PSA density [PSAD] < 0.15 ng/mL/cm3) and low-risk (LR: GG1, cT1-2, PSA ≤ 10 ng/mL) patients undergoing subsequent RP. The Kaplan-Meier method and log-rank test analyzed APF-free survival. Stratified mixed effects models analyzed association.
Out of 21,169 patients on AS, 1742 (VLR: 721; LR: 1021) underwent delayed RP. Most (60.8%) did not have APFs. APFs occurred more frequently (44.6% vs. 31.7%; OR 1.54, p < 0.001) and earlier (median time: 40.3 vs. 62.6 months; p < 0.001) in LR patients, and consisted of pT ≥ 3 (OR 1.47, p = 0.013) or R1 (OR 1.80, p < 0.001), but not of GG ≥ 3 or node involvement. Age (OR 1.05, p < 0.001), PSAD (OR 23.21, p = 0.003), and number of positive cores (OR 1.16, p = 0.004) were independently associated with APFs.
AS stands as a safe option for low-risk patients, and most do not have APFs at surgery. Wider entry criteria are associated with pT3 and R1. The prognostic implications remain uncertain.
Cancers. 2022 Jul 22*** epublish ***
Cristina Marenghi, Zhuyu Qiu, Jozien Helleman, Daan Nieboer, Josè Rubio-Briones, Peter R Carroll, Lui Shiong Lee, Riccardo Valdagni, Paul C Boutros, Nicola Nicolai
Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy., Department of Human Genetics, University of California Los Angeles, Los Angeles, CA 90095, USA., Department of Urology, Erasmus MC Cancer Institute, University Medical Center, 3015 GD Rotterdam, The Netherlands., Department of Urology, Hospital VITHAS 9 de Octubre, 46025 Valencia, Spain., Department of Urology, University of California, San Francisco, CA 94158, USA., Department of Urology, Sengkang General Hospital and Singapore General Hospital, Singapore 544886, Singapore., Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.