Clinical characteristics and pathologic findings in patients eligible for active surveillance who underwent radical prostatectomy

Objective: To analyze clinical characteristics and pathologic findings in patients eligible for active surveillance (AS) who underwent radical prostatectomy (RP). Materials and methods: We collected data from 495 patients who underwent RP during an 8-year period. We have then selected those who would have been eligible for AS according to 2 different sets of published criteria. Group I. used broader criteria: clinical stage <= T2b, Gleason score of seven or less and PSA <= 15 ng/ml. Group 2 used more restrictive criteria: age < 75 years, PSA < 10 ng/ml, clinical stage T1c or T2a, Gleason score of 6 or less, at least 10 biopsies available and a tumor length of less than 3 mm in 2 biopsy cores. Results: Overall, 207 patients (41.8%) were included in group 1 and 43 (8.7%) in group 2. The median follow-up was 31(3-108) and 32 (3-84) months in groups 1 and 2, respectively. We recorded 132 cases (63.8%) of pT2c in group 1 and 31 in group 2 (72.1%). Extracapsular extension was noted in 37 (17.9%) and 2 (4.7%) specimens from groups 1 and 2, respectively. In groups 1 and 2, a biochemical failure occurred in 47 patients (22.7%) and 6 (14%), respectively. The Gleason score at biopsy was underestimated in 54 (26%) and 9 (21%) of patients in groups 1 and 2, respectively. Conclusion: Overall, 21% to 26% of patients eligible for AS had upgraded Gleason scores at prostatectomy and actually had a more significant disease with a potentially aggressive behavior. Therefore, based on criteria, certain tumors currently selected for AS may be significant and may require radical treatment. (C) 2012 Elsevier Inc. All rights reserved.