Cancer progression common in men who undergo deferred prostatectomy
Despite active surveillance, cancer progression appears to be common in men who undergo deferred radical prostatectomy (RP), according to a recent study.
The study included 132 men with screening-detected prostate cancer (median age 64 years) who received radical prostatectomy following active surveillance. Radical prostatectomy was performed upon detection of disease progression or patient request. Active surveillance included prostate-specific antigen (PSA) tests every 3–6 months and biopsies every 2–4 years.
The median time from prostate cancer diagnosis to RP was 1.9 years, during which the participants received a median of one repeat biopsy for active surveillance.
At deferred RP, 52 patients (39 percent) showed at least one unfavourable pathology in the RP specimen. For instance, 35 percent (n=46) of the participants demonstrated an increase in Gleason score (GS) from diagnostic biopsy. Twelve men (9.1 percent) had GS >3+4.
Moreover, 22 percent (n=29) were positive for extraprostatic extensions, 3.0 percent (n=4) had seminal vesicle invasion, 22 percent (n=29) demonstrated positive surgical margins, and 0.8 percent (n=1) had positive lymph nodes. The median tumour volume was 0.70 mL.
PSA relapse was reported in 25 men, 10 of whom underwent salvage radiation. The resulting 10-year PSA relapse-free survival was 79.5 percent.
At the time of diagnostic biopsy, 29 percent (n=38) of the patients had unidentifiable index tumours. At the last repeat biopsy before the deferred surgery, index tumour was not identified in 22 participants (21 percent).
Clinicians can use the findings in counselling prostate cancer patients who choose to undergo active surveillance and deferred RP, researchers said, adding that there is a need to improve the detection of cancer progression during active surveillance.