Association of Age With Risk of Adverse Pathological Findings in Men Undergoing Delayed Radical Prostatectomy Following Active Surveillance



      To determine if older men with Gleason grade group (GG) 1 prostate cancer have a higher risk of having adverse pathology at radical prostatectomy after initially being managed with active surveillance (AS).


      A total of 365 patients with GG1 prostate cancer initially managed with AS followed by delayed radical prostatectomy were identified. The primary outcome was adverse pathology after delayed radical prostatectomy in the men that were <65 years vs. men ≥65 years at the initiation of AS. Adverse pathology was defined as GG ≥3 or pT3 or pN1. Multivariable Cox proportional hazards regression models were used to calculate risk of adverse pathological findings at radical prostatectomy by age group.


      At diagnosis, there were no significant differences in median prostate specific antigen density, percent positive biopsy cores, multiparametric magnetic resonance imaging (mpMRI) results or composite genomic classifier scores (derived from three commercially available genomic tests) between the two age groups. Men ≥65 years had more adverse pathology at radical prostatectomy (59.2% vs. 44.1%, P <0.01) and lower rates of biopsy upgrade-free survival and adverse pathology-free survival (log-rank P <0.01). On multivariable analysis age ≥65 years (Hazard Ratio (HR) 2.21, 95% Confidence Interval (CI) 1.57, 3.12) was associated with adverse pathology at radical prostatectomy. In separate multivariable analyses done for each age group, mpMRI (HR 3.33, 95% CI 1.01, 10.95) was predictor of adverse pathology in the group ≥65 years.


      Older patients might require closer monitoring on AS and additional testing such as mpMRI might improve their risk stratification.
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      1. NCCN Guidelines Version 1.2020.
        Prostate Cancer. 2020;
        • Klotz L
        • Vesprini D
        • Sethukavalan P
        • et al.
        Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.
        J Clin Oncol. 2015; 33: 272
        • Hamdy F.C
        • Donovan JL
        • Lane JA
        • et al.
        10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.
        N Engl J Med. 2016; 375: 1415
        • Druskin SC
        • Mamawala M
        • Tosoian JJ
        • et al.
        Older Age Predicts Biopsy and Radical Prostatectomy Grade Reclassification to Aggressive Prostate Cancer in Men on Active Surveillance.
        J Urol. 2019; 201: 98
        • Leapman MS
        • Cowan JE
        • Nguyen HG
        • et al.
        Active Surveillance in Younger Men With Prostate Cancer.
        J Clin Oncol. 2017; 35: 1898
        • Kim DW
        • Chen MH
        • Huland H
        • et al.
        Association of Age With Risk of Adverse Pathological Findings at Radical Prostatectomy in Men With Gleason Score 6 Prostate Cancer.
        JAMA Netw Open. 2020; 3e202041
        • Tosoian JJ
        • Carter HB
        • Lepor A
        • et al.
        Active surveillance for prostate cancer: current evidence and contemporary state of practice.
        Nat Rev Urol. 2016; 13: 205
        • Selvadurai ED
        • Singhera M
        • Thomas K
        • et al.
        Medium-term outcomes of active surveillance for localised prostate cancer.
        Eur Urol. 2013; 64: 981
        • Schatzl G
        • Madersbacher S
        • Thurridl T
        • et al.
        High-grade prostate cancer is associated with low serum testosterone levels.
        Prostate. 2001; 47: 52
        • Damaschke NA
        • Yang B
        • Bhusari S
        • et al.
        Epigenetic susceptibility factors for prostate cancer with aging.
        Prostate. 2013; 73: 1721
        • Lovf M
        • Zhao S
        • Axcrona U
        • et al.
        Multifocal Primary Prostate Cancer Exhibits High Degree of Genomic Heterogeneity.
        Eur Urol. 2019; 75: 498
        • Ahdoot M
        • Wilbur AR
        • Reese SE
        • et al.
        MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis.
        N Engl J Med. 2020; 382: 917
        • Goldberg H
        • Spratt D
        • Chandrasekar T
        • et al.
        Clinical-genomic Characterization Unveils More Aggressive Disease Features in Elderly Prostate Cancer Patients with Low-grade Disease.
        Eur Urol Focus. 2020;
        • Sukumar S
        • Rogers CG
        • Trinh QD
        • et al.
        Oncological outcomes after robot-assisted radical prostatectomy: long-term follow-up in 4803 patients.
        BJU Int. 2014; 114: 824
        • Menon M
        • Bhandari M
        • Gupta N
        • et al.
        Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up.
        Eur Urol. 2010; 58: 838
        • Chenam A
        • Parihar JS
        • Ruel N
        • et al.
        Lymph node-positive prostate cancer after robotic prostatectomy and extended pelvic lymphadenectomy.
        J Robot Surg. 2018; 12: 425