Appropriately selected men with prostate cancer (PCa) can undergo active surveillance (AS) with delayed radical prostatectomy (RP) without added risk of missing an opportunity for cure as the majority of tumors remain organ confined, according to a study published online in BJU International.

Marc Dall’Era, MD, of the University of California at Davis, and his colleagues studied 1,408 men diagnosed with PCa between 1996 and 2008. The study compared pathological outcomes of men undergoing RP after AS with those of a similar risk group undergoing immediate RP (within three months of diagnosis). The primary outcome of the study was Gleason upgrade to 7 or greater after RP.

At the time of diagnosis, the median age was 59 years and the median PSA level was 5.8 ng/mL. The median time of AS was 18 months. The median follow-up time after surgery was 12 months for the AS group and 27 months for the immediate RP patients. The study revealed no association between treatment group and adverse pathological features at the time of RP for men with low-risk disease at presentation. Among the men in the AS group, 79% had organ-confined disease after RP. 

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The researchers also reported that the current methods of risk stratification may still miss a substantial number of men with higher-risk features. The data “emphasize the important need for close surveillance of men choosing this approach (AS) with the aim of managing their prostate cancer,” the authors wrote. Performing an immediate second biopsy within three months of diagnosis may reduce the risk of clinical undergrading and may identify higher-risk men who should be recommended for more aggressive treatment, Dr. Dall’Era’s team observed.

Although the study has many strengths, it was limited by its retrospective design and unever group sample sizes.