PURPOSE: To study adverse findings in radical prostatectomy of men on an active surveillance program with different entry and exit criteria.
MATERIALS AND METHODS: The study included 80 men with biopsy progression, 33 who opted-out for personal reasons, and 24 who initially did not meet entry criteria mainly due to elevated PSA density.
RESULTS: Men who opted-out had a higher Gleason score 6 (78.8%) than men who progressed on biopsy (46.2%, p=0.002) and men with high PSA density (45.8%, p=0.02). Men with high PSA density had less organ-confined disease than the opt-out group (p< 0.006) and a trend compared to the biopsy progression group (p=0.07). The mean dominant tumor volume was lower (0.56 cc.) in men who opted-out than with biopsy progression (1.1 cc., p=0.03). The incidence of insignificant cancers was higher in men who opted-out (48.4%) than with biopsy progression (28.4%, p=0.05) and with high PSA density (20.8%, p=0.035). There was a higher incidence of anterior tumor in those with high PSA density (55.0%) than with biopsy progression (21.3%, p=0.009) and a trend compared to those who opted-out (27.3%, p=0.06).
CONCLUSION: The majority of men with biopsy progression still have tumors with features of curable disease. Men who opted-out without biopsy progression even have less adverse findings, which supports counseling men to stay on active surveillance while they meet the follow-up criteria. Men with elevated PSA density had more anterior tumors and less organ-confined cancer substantiating that the ideal patients for active surveillance are those that fill all entry criteria.
Written by:
Matoso A, Hassan O, Petrozzino F, Rao BV, Carter HB, Epstein JI. Are you the author?
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD; Department of Urology, The Johns Hopkins Hospital, Baltimore, MD; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD.
Reference: J Urol. 2015 Feb 25. pii: S0022-5347(15)00395-X.
doi: 10.1016/j.juro.2015.02.085
PubMed Abstract
PMID: 25725419