Munich, Germany (UroToday.com) Mallya et al evaluated the oncological outcomes of patients eligible for active surveillance who chose to undergo radical prostatectomy immediately after diagnosis versus those who chose to undergo radical prostatectomy at disease progression.
The group probed a prospectively maintained database to identify those patients eligible for AS. Between 2000 and 2014, 964 patients were eligible for AS as per 2015 EAU guidelines. Criteria for AS was cT1-cT2a, PSA≤10 ng/ml, Gleason Score≤6, ≤2 positive cores on biopsy and percentage involvement ≤50%. The patients were divided into those who underwent radical prostatectomy within 6 months (Group A) or > 6 months (Group B). Patients in Group B were further classified into patients who elected to undergo prostatectomy without prior AS (Group B1) or those who were on initial AS and progressed (Group B2). Clinicopathologic characteristics were obtained and compared.
Group A had 820 patients while Group B had 144 patients of which Group B1 had 118 and Group B2 had 26. Radical prostatectomy was performed at a median of 3 months (Group A), 9 months (Group B1), and 19 months (Group B2). Clinical characteristics such as age at operation, BMI, preoperative PSA and biopsy characteristics were comparable between all groups. Histopathological features on radical prostatectomy were also similar. Compared to Group A, patients in Group B had an earlier median time to biochemical relapse (31 vs 43 months) and a higher rate of progression to biochemical relapse (7.6% vs 3.9%, p = 0.045). Patients in Group B2 had an even earlier median time to biochemical relapse when compared to Group B1 or Group A.
The group concludes that delayed prostatectomy in AS eligible prostate cancer is associated with higher biochemical recurrence. Greatest rate of biochemical relapse was seen in those on AS who progressed. Early identification of this subset of patients who may progress is essential to improve oncological outcomes.
Reported By:
Mohammed Haseebuddin, MD, at the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany
Fox Chase Cancer Center