ORIGINAL ARTICLES   

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

Copyright © 2015 EDIZIONI MINERVA MEDICA

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.