Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically

OBJECTIVE To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series. PATIENTS AND METHODS From 1080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level < 10 ng/mL, clinical stage < T2a and biopsy Gleason score < 6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of 'insignificant' disease were assessed. RESULTS The mean age of the patients was 61 years, the mean (range) PSA level was 6.1 (1-9) ng/mL; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score >= 7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%) and biochemical failure occurred in six patients (1.1%) with a median follow-up of 28 months. CONCLUSION In this contemporary UK cohort of patients with apparently low- or favourable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harbouring more significant disease.