Open Access

ARTICLE

Impact of active surveillance on pathology and nerve sparing status

Rachael Sussman¹, Ilene Staff², Joseph Tortora², Alison Champagne², Anoop Meraney², Stuart S. Kesler³, Joseph R. Wagner³

1 University of Connecticut Health Center, Farmington, Connecticut, USA
2 Research Program, Hartford Hospital, Hartford, Connecticut, USA
3 Urology Division, Hartford Healthcare Medical Group, Hartford, Conneticut, USA
Address correspondence to Dr. Joseph R. Wagner, MD, Urologic Oncology and Minimally Invasive Surgery, Hartford Healthcare Medical Group, 85 Seymour Street, 4^th Floor - Suite 416, Hartford, CT 06106 USA

Canadian Journal of Urology 2014, 21(3), 7299-7304.

Abstract

Introduction: We assessed whether, in comparison to immediate surgery, a time delay in performing radical prostatectomy (RP) in patients electing to undergo a period of active surveillance (AS) of low grade prostate cancer, is associated with adverse pathologic features, biochemical recurrence and the ability to perform effective nerve sparing surgery.
Materials and methods: From our RP database of 2769 patients, we identified 41 men under AS who subsequently underwent RP. This study group was compared to control group A (164 patients who chose RP rather than AS), matched for prostate-specific antigen (PSA) and initial diagnostic biopsy characteristics. With time, PSA and biopsy characteristics in the AS study group changed, prompting these men to undergo RP. These changes were matched to create a separate control group B (123 patients most of whom did not meet AS criteria). The incidence of nerve sparing surgery, pathologic features, and biochemical recurrence were compared. Outcome variables were compared using Chi-square tests of proportions. Fisher’s Exact test was used for recurrence rates due to the low expected frequencies in some cells.
Results: Compared with control group A, the AS patients experienced higher rates of Gleason score upgrading (33/41; 81.1% versus 76/164; 46.3%, p < 0.001), biochemical recurrence (5/41; 11.4% versus 2/164; 1.3%, p = 0.012) and lower rates of bilateral nerve sparing surgery (31/41; 75.6% versus 154/164; 93.9%, p < 0.001). Control group B and active surveillance group were comparable across all indices measured.
Conclusions: Delaying RP, through undergoing a period of AS, had a significant negative impact on the incidence of bilateral nerve sparing surgery and adverse pathologic features when compared to patients with similar parameters at the time of diagnosis. Close monitoring and surveillance biopsies did not improve pathologic outcomes compared to patients from whom a single diagnostic biopsy was obtained (and were not candidates for AS), and who subsequently underwent immediate surgery.

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