Predictors of Adverse Pathology in Men Undergoing Radical Prostatectomy Following Initial Active Surveillance

OBJECTIVE: To report pathologic outcomes and predictors of adverse pathology in men undergoing radical prostatectomy (RP) after an initial period of active surveillance (AS).

METHODS: We studied pathologic outcomes in men who underwent RP after some time on AS. Pathologic outcomes were compared between men with and without evidence of disease reclassification on AS. Rates of adverse pathology (defined as pathologic stage ≥ pT3a, RP Gleason ≥ 4+3, or lymph node involvement) were determined and were compared depending on the variable that defined disease reclassification.

RESULTS: Of 1086 men enrolled in AS, 130 (12.0%) underwent RP after a median time of 1.96 years (range, 0.55-12.26 years) on AS. Ninety-seven (74.6%) of these men had evidence of disease reclassification on AS. Rates of adverse pathology were greater in men with evidence of reclassification compared to those without (P = .05). Among men with disease reclassification, rates of adverse pathology ranged from 23.8% to 44.7% depending on the variable used to define reclassification. Longer time on AS was not associated with adverse pathology (P = .68).

CONCLUSION: Adverse pathology after RP is more common in men with evidence of disease reclassification on AS compared to those undergoing RP for other reasons. However, we identified varying outcomes among these patients depending on the criterion that defined reclassification. These data may enable identification of men who can safely continue on AS despite evidence of disease reclassification.