Pathologic Findings in Radical Prostatectomy Specimens From Patients Eligible for Active Surveillance With Highly Selective Criteria: A Multicenter Study - 25/08/12

Doi : 10.1016/j.urology.2012.04.051

Jean-Baptiste Beauval ^a,^⁎ , Guillaume Ploussard ^b, Michel Soulié ^a, Christian Pfister ^c, Simon Van Agt ^c, Sébastien Vincendeau ^d, Sébastien Larue ^e, Jérome Rigaud ^e, Nicolas Gaschignard ^f, Morgan Rouprêt ^g, Sarah Drouin ^g, Mickael Peyromaure ^h, Jean Alexandre Long ⁱ, Francois Iborra ^j, Guy Vallancien ^k, Francois Rozet ^k, Laurent Salomon ^b
Members of Committee of Cancerology of the French Association of Urology (CCAFU)
^a Urology Department, Rangueil University Hospital, Toulouse, France
^b Urology Department, Henri Mondor Hospital, Créteil, France
^c Urology Department Charles Nicolle Hospital, Rouen, France
^d Urology Department, Rennes Hospital, Rennes, France
^e Urology Department, Nantes Hospital, Nantes, France
^f Urology Department, Hospital, La Roche-sur-Yon, France
^g Urology Department, Pitié Salpêtrière Hospital, Paris, France
^h Urology Department, Cochin Hospital, Paris, France
ⁱ Urology Department, Grenoble Hospital, Grenoble, France
^j Urology Department, Lapeyronie Hospital, Montpellier, France
^k Urology Department, Montsouris Institut, Paris, France

Reprint requests: Jean Baptiste Beauval, M.D., Urology Department, Rangueil University Hospital, 1 Av J. Poulhès 31059, Toulouse CEDEX, France

Résumé

Objective

To evaluate the pathologic features of surgical specimens after radical prostatectomy in patients with low-risk prostate cancer fulfilling the strictest pathologic selection criteria for active surveillance.

Methods

Retrospective analysis of 10 785 consecutive radical prostatectomy performed in 10 university hospitals (January 2003 through December 2008). A total of 919 patients fulfilled the following unique and very stringent criteria: T1c, prostate-specific antigen (PSA) <10 ng/mL, a single positive biopsy, tumor length <3 mm, and Gleason score <7. Clinico-biologic and pathologic data at diagnosis and after radical prostatectomy, prostatic and tumor volume, pathologic Gleason score and stage, positive surgical margins, insignificant prostate cancer, and PSA outcomes were recorded.

Results

Median age was 63 years. Mean prebiopsy PSA level was 6.2 ng/mL. At radical prostatectomy, Gleason score was upgraded in 34% of patients, including 1.2% Gleason score 8-9. Pathologic stages were pT2 in 87.3%, pT3 in 11.1%, and pT4 in 1.4% of cases. Extraprostatic extension was found in 12.5%. Only 26% of patients had “insignificant” tumors. Biochemical recurrence-free survival at 5 years was 92.3%. There was no significant difference in survival between patients with “significant” and “insignificant” tumors (90.1% vs 93.4%; P = .06).

Conclusion

Despite of a stringent selection of patients with low-risk prostate cancer, active surveillance definition included a significant proportion of patients with upstaged (about 12%) and upgraded (about one-third) disease at diagnosis. Only a quarter of active surveillance patients have a pathologically confirmed “insignificant” cancer.

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