Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically

BJU Int. 2009 Nov;104(10):1501-4. doi: 10.1111/j.1464-410X.2009.08597.x. Epub 2009 May 7.

Abstract

Objective: To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series.

Patients and methods: From 1080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level <10 ng/mL, clinical stage < or =T2a and biopsy Gleason score < or =6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of 'insignificant' disease were assessed.

Results: The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1-9) ng/mL; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score > or =7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%) and biochemical failure occurred in six patients (1.1%) with a median follow-up of 28 months.

Conclusion: In this contemporary UK cohort of patients with apparently low- or favourable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harbouring more significant disease.

MeSH terms

  • Epidemiologic Methods
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prostate / pathology*
  • Prostate / surgery
  • Prostate-Specific Antigen / blood
  • Prostatectomy / methods*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery*
  • Seminal Vesicles / pathology
  • Treatment Outcome

Substances

  • Prostate-Specific Antigen