Pathological Features After Radical Prostatectomy in Potential Candidates for Active Monitoring

Abstract

More than a third of Gleason 3 + 3 tumors on biopsy were upgraded in the radical prostatectomy specimen or had other adverse pathological features. Our results suggest that low volume Gleason 3 + 3 prostate cancer is frequently under staged, and that immediate therapy with radical prostatectomy is associated with favorable outcomes.

Outcomes and follow-up strategies for patients on active surveillance

“…We are unable ascertain from these data precisely what was lost by waiting as it is impossible to know the pathologic stage for these men at the time of diagnosis. These data, however, are comparable to those described from surgical series with similarly low risk men undergoing immediate radical prostatectomy [7].…”

“…The Canadian experience reports a lower rate of 4%, likely due to the enrollment of men with limited pattern four at the time of diagnosis [2]. These data are not surprising given the well characterized 20-30% discordance rate between prostate biopsy and pathologic Gleason score for men undergoing immediate radical prostatectomy [6,7]. Furthermore, these data underscore the importance of incorporating repeat prostate biopsies into an active surveillance strategy.…”

Final pathohistology after radical prostatectomy in patients eligible for active surveillance (AS)

“…In a comparable paper [11] by R. Griffin et al, 292 men were studied who had a maximum of two positive cores in the biopsy of the prostate and a Gleason Score of 6. This study came to the following conclusions: The tumor stage and/or the degree of differentiation in patients with a preoperative "low-volume Gleason 3 + 3" prostate carcinoma was underestimated in one-third of cases.…”

Perspectives on the clinical management of localized prostate cancer

“…The problem, of course, is the inability to accurately characterize a prostate cancer without actually removing it. In a series of 292 patients with favorable pathology on prostate biopsy (defined as 2 cores or less with cancer, less than 50% of any core with cancer and no Gleason pattern 4 or 5), 27% had upgrading in the radical prostatectomy specimen 11. In that cohort, only 8% of the patients met the criteria of insignificant cancer.…”