Sunday June 30, 2019 from 07:30 to 09:00
Does time spent on active surveillance adversely affect the pathological and oncological outcomes in patients undergoing delayed radical prostatectomy?
Ardalan Ahmad1, Patrick Richard1, Narhari Timilshina1, Maria Komisarenko1, Girish S. Kulkarni1, Robert Hamilton1, Alexandre Zlotta1, Neil E. Fleshner1, Antonio Finelli1.
1Division Urology, Department Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
Introduction: The pathological and oncological outcomes of men undergoing radical prostatectomy (RP) following a period of active surveillance (AS) for favourable-risk prostate cancer (PCa) is not well-established. We aimed to asses pathological and oncological outcomes for men with favorable-risk PCa on AS progressing to RP for clinically significant PCa (Gleason group ≥2).
Methods: A prospectively maintained AS database at Princess Margaret Cancer Centre (PMCC) was queried to identify patients progressing to RP (n=294) between 1992 and 2015. Patients undergoing RP for clinically significant PCa were selected (ASRP, n=171). Clinical and pathological characteristics at the time of progression to RP (age, prostate-specific antigen [PSA], year of biopsy, Gleason score, and primary Gleason grade) were used to compare pathological and oncological outcomes to a matched cohort of patients treated with upfront RP at diagnosis (n=407).
Results: One hundred seventy-one patients underwent RP after a median of 31.0 months (interquartile range [IQR] 30.0–44.0) on AS. At RP, the rate of pT3, pN1, and positive surgical margin rate were comparable between ASRP and matched controls. The ASRP cohort had a smaller cancer volume and lower extraprostatic extension (EPE) and seminal vesicle invasion (SVI) rate. Median followup after RP was 4.9 (IQR 3.1–6.9) years. Biochemical recurrence (BCR) occurred in 24 (14%) and 78 (19%) of ASRP and matched controls, respectively (p=0.14). At five years, the BCR-free survival rate in the ASRP cohort and upfront RP cohort were 85.6% and 79.2%, respectively (p=0.112). The retrospective, single-centre nature of the study is a limitation.
Conclusions: Curative-intent RP after a period of AS renders excellent pathological and oncological outcomes at five years. Moreover, the delay of therapy after a period of AS does not appear to result in inferior oncological outcomes compared to patients with similar risk characteristics undergoing upfront RP.