Treatment Outcomes of Radical Prostatectomy in Potential Candidates for 3 Published Active Surveillance Protocols
Received 6 May 2009; accepted 20 July 2009. published online 07 December 2009.
Objectives
To examine the treatment outcomes of men who would have been eligible for active surveillance (AS) but underwent immediate radical retropubic prostatectomy (RRP). AS protocols are designed to spare the potential morbidity of treatment to patients with low-risk prostate cancer (PCa).
Methods
From a prospective RRP database, we evaluated the tumor features and treatment outcomes for men who would have met 1 of 3 published AS criteria: (1) clinically localized disease, Gleason ≤7, and no significant comorbidities (Patel et al, J Urol. 2004;171:1520-1524) (2) T1b-T2b N0M0 disease, Gleason ≤7, and prostate-specific antigen ≤15 ng/mL (Choo R et al. J Urol. 2002;167:1664-1669), or (3) T1c PCa (Mohler JL et al. World J Urol. 1997;15:364-368.).
Results
3959, 3536, and 2330 RRP patients, respectively, would have met these AS criteria. At surgery, 3%-4% had a Gleason score of 8-10, 16%-19% had positive surgical margins, 15%-18% had extracapsular tumor extension, 3%-5% had seminal vesicle invasion, and 0.4%-1% had lymph node metastasis. The 5-year progression-free survival rate ranged from 84%-89%. Metastasis occurred in 0.1%-1.2%, and 0.1%-0.9% died of PCa. On multivariate analysis, Gleason score >6 was the strongest predictor of biochemical progression.
Conclusions
A substantial proportion of men who might have been considered potential AS candidates had aggressive tumor features at RRP and/or progression. Biopsy Gleason score >6 was the strongest predictor of adverse outcomes, highlighting the importance of limiting AS to patients with Gleason ≤6. Overall, the accurate identification of patients with truly indolent PCa at the time of diagnosis remains challenging.
aDepartment of Urology, Northwestern Feinberg School of Medicine, Chicago, Illinois
bRobert H. Lurie Comprehensive Cancer Center, Northwestern Feinberg School of Medicine, Chicago, Illinois
cDepartment of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
dDepartment of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Reprint requests: William J. Catalona, M.D., Robert H. Lurie Comprehensive Cancer Center, Northwestern Feinberg School of Medicine, 675 N St Clair, Suite 20–150, Chicago, IL 60611
Supported by the Urological Research Foundation, Beckman Coulter, Inc., the Prostate SPORE grant (P50 CA90386-05S2) and the Robert H. Lurie Comprehensive Cancer Center grant (P30 CA60553) (to (W.J.C.).
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