PURPOSE: To study adverse findings in radical prostatectomy of men on an active surveillance program with different entry and exit criteria.
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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.
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.