Predictors of Adverse Pathology in Men Undergoing Radical Prostatectomy Following Initial Active Surveillance.

To report pathological outcomes and predictors of adverse pathology in men undergoing radical prostatectomy (RP) after an initial period of active surveillance (AS).

We studied pathological outcomes in men who underwent RP after some time on AS.

Pathological outcomes were compared between men with and without evidence of disease reclassification on AS. Rates of adverse pathology (defined as pathological stage≥pT3a, RP Gleason ≥4+3, or lymph node involvement) were determined, and were compared depending on the variable that defined disease reclassification.

Of 1086 men enrolled in AS, 130 (12. 0%) underwent RP after a median time of 1. 96 years (range 0. 55-12. 26 years) on AS. 97 (74. 6%) of these men had evidence of disease reclassification on AS. Rates of adverse pathology were greater in men with evidence of reclassification compared to those without (p=0. 05). Among men with disease reclassification, rates of adverse pathology ranged from 23. 8% to 44. 7% depending on the variable used to define reclassification. Longer time on AS was not associated with adverse pathology (p=0. 68).

Adverse pathology after RP is more common in men with evidence of disease reclassification on AS compared to those undergoing RP for other reasons. However, we identified varying outcomes among these patients depending on the criterion that defined reclassification. These data may enable identification of men who can safely continue on AS despite evidence of disease reclassification.

Urology. 2015 Aug 31 [Epub ahead of print]

Adam C Reese, Zhaoyong Feng, Patricia Landis, Bruce J Trock, Jonathan I Epstein, H Ballentine Carter

Department of Urology, Temple University School of Medicine, Philaldelphia, PA. Electronic address: adam. reese@tuhs. temple. edu. , The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD. , The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD. , The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD. , The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD. , The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD.

PubMed