Radical Prostatectomy Findings in Patients in Whom Active Surveillance of Prostate Cancer Fails

No AccessJournal of UrologyAdult Urology1 Nov 2009Radical Prostatectomy Findings in Patients in Whom Active Surveillance of Prostate Cancer Fails Amy S. Duffield, Thomas K. Lee, Hiroshi Miyamoto, H. Ballantine Carter, and Jonathan I. Epstein Amy S. DuffieldAmy S. Duffield Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author , Thomas K. LeeThomas K. Lee Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author , H. Ballantine CarterH. Ballantine Carter Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author , and Jonathan I. EpsteinJonathan I. Epstein Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.07.024AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Little data are available on radical prostatectomy findings in men who experience disease progression following active surveillance. Materials and Methods: A total of 470 men in our active surveillance program underwent annual repeat needle biopsies to look for progression defined as any Gleason pattern grade 4/5, more than 50% cancer on any core or cancer in more than 2 cores. Slides were available for review in 48 of 51 radical prostatectomies with progression. Results: The average time between the first prostate biopsy and radical prostatectomy was 29.5 months (range 13 to 70), with 44% and 75% of the patients showing progression by the second and third biopsy, respectively. There were 31 (65%) organ confined cases, of which 25 (52%) were Gleason score 6. Of 48 cases 17 (35%) had extraprostatic extension, 3 had seminal vesicle/lymph node involvement and 7 (15%) had positive margins. Mean total tumor volume was 1.3 cm3 (range 0.02 to 10.8). Of the 48 tumors 13 (27%) were potentially clinically insignificant (organ confined, dominant nodule less than 0.5 cm3, no Gleason pattern 4/5) and 19% (5 of 26) of the radical prostatectomies with a dominant tumor nodule less than 0.5 cm3 demonstrated extraprostatic extension, 4 with Gleason pattern 4. All 10 tumors with a dominant nodule greater than 1 cm3 were located predominantly anteriorly. Conclusions: Most progression after active surveillance occurs 1 to 2 years after diagnosis suggesting undersampling of more aggressive tumor rather than progression of indolent tumor. Even with progression most tumors have favorable pathology (27% potentially insignificant). A small percentage of men have advanced stage disease (pT3b or N1). The anterior region should be sampled in men on active surveillance. References 1 : The changing face of prostate cancer. J Clin Oncol2005; 23: 8146. Google Scholar 2 : Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience. J Urol2007; 178: 2359. Link, Google Scholar 3 : Residual tumor potentially left behind after local ablation therapy in prostate adenocarcinoma. J Urol2008; 179: 2203. Link, Google Scholar 4 : Lead times and overdetection due to prostate specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst2003; 95: 868. 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Google Scholar © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byWhalen M, Hackert V, Rothberg M, McKiernan J, Benson M and Badani K (2016) Prospective Correlation between Likelihood of Favorable Pathology on the 17-Gene Genomic Prostate Score and Actual Pathological Outcomes at Radical ProstatectomyUrology Practice, VOL. 3, NO. 5, (379-386), Online publication date: 1-Sep-2016.Dall’Era M, Maddala T, Polychronopoulos L, Gallagher J, Febbo P and Denes B (2015) Utility of the Oncotype DX® Prostate Cancer Assay in Clinical Practice for Treatment Selection in Men Newly Diagnosed with Prostate Cancer: A Retrospective Chart Review AnalysisUrology Practice, VOL. 2, NO. 6, (343-348), Online publication date: 1-Nov-2015.Matoso A, Hassan O, Petrozzino F, Rao B, Carter H and Epstein J (2015) Radical Prostatectomy Findings in Men on Active Surveillance: Variable Findings Dependent on Reason for Surgery and Entry CriteriaJournal of Urology, VOL. 194, NO. 3, (685-689), Online publication date: 1-Sep-2015.Wang C, Carter H and Epstein J (2013) Value of Transition Zone Biopsy in Active Surveillance of Prostate CancerJournal of Urology, VOL. 191, NO. 6, (1755-1759), Online publication date: 1-Jun-2014.Lee D, Koo K, Lee S, Rha K, Choi Y, Hong S and Chung B (2013) Tumor Lesion Diameter on Diffusion Weighted Magnetic Resonance Imaging Could Help Predict Insignificant Prostate Cancer in Patients Eligible for Active Surveillance: Preliminary AnalysisJournal of Urology, VOL. 190, NO. 4, (1213-1217), Online publication date: 1-Oct-2013. 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Volume 182Issue 5November 2009Page: 2274-2279 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsprostatic neoplasmsprostatectomyMetrics Author Information Amy S. Duffield Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author Thomas K. Lee Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author Hiroshi Miyamoto Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author H. Ballantine Carter Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author Jonathan I. Epstein Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...