Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active Surveillance

Rebecka Arnsrud Godtman; Max Schafferer; Carl-Gustaf Pihl; Johan Stranne; Jonas Hugosson

doi:10.1016/j.juro.2018.04.078

Long-Term Outcomes after Deferred Radical Prostatectomy in Men Initially Treated with Active Surveillance

J Urol. 2018 Oct;200(4):779-785. doi: 10.1016/j.juro.2018.04.078. Epub 2018 May 3.

Authors

Rebecka Arnsrud Godtman¹, Max Schafferer², Carl-Gustaf Pihl², Johan Stranne², Jonas Hugosson²

Affiliations

¹ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Pathology, Institute of Biomedicine (CGP), Sahlgrenska Academy at University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: [email protected].
² Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Pathology, Institute of Biomedicine (CGP), Sahlgrenska Academy at University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden.

PMID: 29730198
DOI: 10.1016/j.juro.2018.04.078

Abstract

Purpose: We sought to determine long-term outcomes after deferred radical prostatectomy.

Materials and methods: The study population consisted of all 132 men with screening detected prostate cancer who underwent deferred radical prostatectomy from January 1, 1995 to December 31, 2014 after active surveillance in the Göteborg Randomized, Population-based Prostate Cancer Screening Trial. The last date of followup was May 15, 2017. Followup during active surveillance was performed with prostate specific antigen tests every 3 to 6 months and repeat biopsies every 2 to 4 years. Triggers for radical prostatectomy were disease progression based on prostate specific antigen, grade and/or stage, or patient request. Outcomes included adverse pathology findings at radical prostatectomy, defined as Gleason score greater than 3 + 4, extraprostatic extension, positive margins, seminal vesicle invasion and/or N+, whether the index tumor at radical prostatectomy was identified at biopsy and prostate specific antigen relapse-free survival. Kaplan-Meier analysis was performed.

Results: Median time from diagnosis to surgery was 1.9 years (IQR 1.2-4.2) and median postoperative followup was 10.9 years (IQR 7.5-14.5). A total of 52 men (39%) experienced at least 1 unfavorable pathology feature at radical prostatectomy. The 10-year prostate specific antigen relapse-free survival was 79.5%. The index tumor was not identified in the diagnostic biopsy in 38 of the 132 men (29%) or at the last repeat biopsy that preceded radical prostatectomy 22 of 105 (21%).

Conclusions: A large proportion of men had unfavorable pathology findings at deferred radical prostatectomy and the index tumor was frequently not identified. There is a clear need for better risk classification and protocols to determine disease progression during active surveillance.

Keywords: disease progression; mass screening; prostatectomy; prostatic neoplasms; watchful waiting.

Publication types

Comparative Study
Randomized Controlled Trial

MeSH terms

Aged
Biopsy, Needle
Disease Progression
Disease-Free Survival
Early Detection of Cancer / methods*
Humans
Immunohistochemistry
Male
Middle Aged
Neoplasm Grading
Prognosis
Prostate-Specific Antigen / blood*
Prostatectomy / methods*
Prostatectomy / mortality
Prostatic Neoplasms / mortality*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / surgery*
Risk Assessment
Survival Analysis
Time Factors
Treatment Outcome
Watchful Waiting / methods*

Substances

Prostate-Specific Antigen