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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2015 March;67(1):1-9


language: English

Pathologic findings in patients who underwent robot-assisted radical prostatectomy following active surveillance: a prospective study in a single center

Ha Y.-S. 1, 2, Yu J. 1, 3, Patel N. 1, Hassanzadeh Salmasi A. 1, Parihar J. 2, Kwon T. G. 2, Kim W.-J. 4, Kim I. Y. 1

1 Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ USA;
2 Department of Urology, School of medicine, Kyungpook National University Medical Center, Daegu, Korea;
3 Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea;
4 Department of Urology, Chungbuk National University, College of Medicine, Cheongju, Korea


AIM: Active surveillance is the recommended treatment of option for men with very low-risk prostate cancer. In this study, the clinicopathological results of patients who were initially treated with active surveillance and subsequently underwent robot-assisted radical prostatectomy during follow-up are described.
METHODS: A prospective cohort of 106 men enrolled in active surveillance was reviewed. Pathologic specimens for patients who ultimately underwent robot-assisted radical prostatectomy for progression or personal preference were analyzed.
RESULTS: After exclusion of 14 patients who were lost to follow-up or with incomplete data collection, 92 men were included in the present analyses. Median follow-up was 27.6 months (range 3.3 to 193.1). Twenty-nine patients underwent robot-assisted radical prostatectomy. Progression occurred in 32 patients (34.8%), of which 23 men elected to undergo surgery. Robot-assisted radical prostatectomy was performed in 6 additional patients who chose definitive intervention due to anxiety. Pathologic analyses revealed organ-confined disease in 24 patients (82.8%), and Gleason score was ≥7 in nine (31%). Fourteen (48.3%) specimens were identified as having an advanced disease (Gleason score ≥7 and/or T3). In comparison to the patients with low-risk disease post-operatively (Gleason score <7 and T2), patients with advanced disease had significantly higher PSA density level and lower prostate volume.
CONCLUSION: In this prospective active surveillance cohort, the progression rate was 34.8% over the follow-up period of 27.6 months. In specimens of patients who underwent robot-assisted radical prostatectomy, 48.3% displayed advanced pathologic features. Therefore we recommend that patients considering active surveillance should be counseled on risk of advanced disease as a possible hazard.

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