Poor association between the progression criteria in active surveillance and subsequent histopathological findings following radical prostatectomy

Abstract

Objective. The objective of this study was to investigate the association between active surveillance (AS) progression criteria and histopathology features in subsequent radical prostatectomy (RP) specimens. Materials and methods. Of 229 patients managed on AS, 80 patients underwent RP, of whom 68 met at least one of the following three progression criteria: progression on rebiopsy, short prostate-specific antigen (PSA) doubling time (PSAdt) and increase clinical tumour category (cT). Patients revealing histopathological features in the RP specimens involving GS ≥ 7 (3 + 4) were considered to have achieved a potential survival gain from the procedure (timely RP). The association between the progression criteria and timely RP was analysed using univariate logistic regression analyses. Results. Of the 68 patients who met at least one of the progression criteria, 66% had timely RP features. Progression on rebiopsy was significantly associated with timely RP [odds ratio (OR) = 5.00, 95% confidence interval (CI) 1.51-16.51]. Although not statistically significant, progression defined by PSAdt was negatively associated with timely RP (OR = 0.36, 95% CI 0.13-1.00). Increase in cT showed no association with timely RP (OR = 1.17, 95% CI 0.35-3.87). Conclusions. A poor association was found between the progression criteria employed in the AS programme and histopathology features after subsequent RP. Only progression on rebiopsy was significantly associated with final histopathology.

Key Words:

• Active surveillance
• progression criteria
• prostate cancer
• radical prostatectomy

Acknowledgements

The authors would like to thank IMK Almene Fond for grants supporting the present study and Ib Jarle Christensen (The Finsen Laboratory, Copenhagen Biocenter and Biotech Research and Innovation Centre, Rigshospitalet) for statistical consultation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.