Long-term surveillance outcomes of prostate cancer patients eligible for active surveillance but who underwent radical prostatectomy

Abstract

Objective: We aimed to investigate the long-term surveillance outcomes (biochemical recurrance, survival) and adequacy of active surveillance criteria to detect low-risk prostate cancer patients who were eligible for active surveillance but underwent radical prostatectomy. Materials and Methods: Data of patients who underwent radical prostatectomy for prostate cancer between January 2005 and January 2019 were retrospectively evaluated. Upstaging, upgrading, surveillance periods, and survival status of patients with clinical stage T1c and T2a, serum prostate-specific antigen below 10 ng/mL, International Society of Urological Pathology grade 1, number of tumor-positive cores in biopsy 2 and below, tumor percentage in tumor-positive cores 50 and below were inclusion criteria for active surveillance. Results: The study included 606 patients. Of these patients, 184 (30.4%) met the inclusion criteria for active surveillance. Upgrading was detected in 77 (41.8%) patients and upstaging in 29 (15.8%) patients who met the criteria for active surveillance. The prostate-specific antigen (PSA) and PSA density values of the patients who met the active surveillance criteria were significantly lower than those of the other patients (p<0.05). The mean surveillance period was 127.6±49.6 (8-227) months, and 123 patients died during this period. Among them, 18 (3%) patients died because of related causes of prostate cancer. None of the patients who met the criteria for active surveillance died because of prostate cancer (p=0.018). Conclusion: No cancer-related deaths were observed in patients who is eligible for active surveillance but underwent radical prostatectomy. This may suggest that active surveillance criteria are suitable for detecting low-risk prostate cancer patients.