The risk of adverse findings at surgery for men with very low risk (VLR) prostate cancer is significantly lower than for those with low risk (LR), according to research published in The Journal of Urology (2013;190:1219-1223).

Jeffrey J. Tosoian, MD, of Johns Hopkins Hospital in Baltimore, and colleagues prospectively studied the oncologic outcomes at surgery in 7,486 men with LR (7,333 patients) and VLR (153 patients) prostate cancer who were candidates for active surveillance.

Upon final pathology, 21.8% of men with LR prostate cancer had a Gleason score upgrade and 23.1% had non-organ confined cancer. However, for men with VLR prostate cancer, only 13.1% required a Gleason score upgrade and 8.5% exhibited non-organ confined cancer on final pathology. Overall, men with LR prostate cancer were twofold more likely to experience a Gleason score upgrade or non-organ-confined cancer, respectively, compared with men with VLR prostate cancer.

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“The likelihood of a more aggressive pathological phenotype differs among men with LR and VLR prostate cancer who are eligible for active surveillance,” the authors wrote. “This may provide additional guidance in identifying subjects most appropriate for surveillance and counseling those men considering surveillance as an alternative to immediate curative intervention.”