Outcomes are similar between men with histologically comparable prostate cancer (PCa) who receive a radical prostatectomy (RP) after a period of active surveillance (AS) and those with low-risk disease who undergo immediate prostatectomy, according to a study published in The Journal of Urology (2013;190:91-96).
Raj Satkunasivam, MD, of the University of Toronto, and colleagues identified patients on AS treated with RP. They compared 289 AS patients who were ultimately treated with RP to age- and PSA-matched men undergoing immediate RP after a diagnosis of low-risk disease who were candidates for AS (group 1). Patients on AS with progression to Gleason 7 disease were also compared with men treated who had similar de novo disease (group 2).
The RP-after-AS group had worse pathological outcomes compared to group 1, whereas group 2 and those patients undergoing RP after AS with progression to Gleason 7 disease had similar pathologic outcomes. Biochemical recurrence was low and comparable between the RP-after-AS group and group 1 (2.6% vs. 5.4% at a median of 3.5 years after RP. Both groups had comparable erectile function and continence.
“Radical prostatectomy after a period of active surveillance does not appear to result in adverse pathological outcomes compared to patients with a similar preoperative pathology,” the authors concluded.