Introduction and Objectives
Active surveillance (AS) is a very promising approach to prostate cancer treatment which is based on understanding to biologic behaviour of prostate cancer. Criterions for AS are very well known – staging ≤T2, Gleason score ≤3+3a PSA ≤10 ng/ml. Aim of our study was to reveal the risk of presence of aggressive prostate cancer on the strenght of available data from bioptic and postprostetectomy staging and grading when indicating active surveillance.
Material and Methods
During January 2003 to June 2009 we gathered clinical data from 560 consecutive patients who underwent radical prostatectomy. We evaluated preoperative PSA, bioptic and postoperative Gleason score and clinical and pathological staging. All the specimens were assessed by experienced pathologist from our Teaching Hospital to minimize interindividual variability of evaluating.
Preoperative conditions for enrolling the patients to active surveillance, i.e. staging ≤T2, Gleason score ≤3+3a PSA ≤10 ng/ml fulfilled 83 patients. Comparing the postoperative grading and staging worsening of one or both parameters occured in total in 59% of patients – upgrading in 42 patients (50.6%), upstaging in 1 patient (1.2%) and both parameters worsened in 6 patients (7.2%). On the other hand 41% of patients according to final pathological report would still fulfill conditions for active surveillance.
At the time of detecting more and more insignificant prostate carcinomas active surveillance belongs to options how to prevent the patients or postpone potential serious adverse events resulting from the treatment with curative intent. Preoperatively in 59% of patients we supposed the patients were in low risk group. When knowing the histology after radical prostatectomy these patients were put in intermediate or high risk group. Despite these results we apprehend active surveillance as a very promising options for carefully selected group of patients with regard to PSA kinetics, Gleason sum in prostate rebiopsy and clinical course of the disease. Both the patient and the urologicist must understand that choosing active surveillance does not necessarily mean avoiding active radical therapy in the future.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.