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Active surveillance prior to radical prostatectomy is not associated with rates of biochemical recurrence
Likhit Agrawal, BS1, Rebekka S. Garcia, MPH2, Andrew W. Hahn, MD2, Taryn Ellis, MD2, Brian F. Chapin, MD2, John W. Davis, MD2, John W. Ward, MD2, Curtis Pettaway, MD2, Lisly Chery, MD2, Daniel Igel, MD2, Patricia Troncoso, MD2, Miao Zhang, MD2, Ethan Bui, BS1, Avani Shepard, BS1, Janis Busse, BS1, Justin R. Gregg, MD2.
1McGovern Medical School at UT Health Houston, Houston, TX, USA, 2MD Anderson Cancer Center, Houston, TX, USA.
Background: Active surveillance (AS) is increasingly used in the management of localized prostate cancer. Radical prostatectomy (RP) remains a primary curative treatment; however, concerns remain about increased risks of disease progression and biochemical recurrence (BCR) in the setting of delayed RP. We sought to evaluate whether prior AS is associated with increased rates of BCR following RP.
Methods: We performed a retrospective cohort study of 4,841 patients undergoing RP, stratified by presurgical AS status (yes/no). A multivariable logistical regression was performed in Stata 19 to assess the association between AS and BCR, adjusting for age at diagnosis, biopsy Grade Group and pathologic stage at RP. Statistical significance was defined as p<0.05. Sensitivity analyses were conducted among margin negative patients.
Results: Of 4,841 patients, 198 (4.1%) underwent AS and 4,643 did not. Mean age was 61.48 (IQR 54.1-68.8)
. Median follow-up to BCR was shorter in the AS cohort at 21.5 months (IQR 2.4-40.6, n=30) compared to non-AS at 37.7 (IQR -158.6-234, n=1,095). As expected, increased pathological stage was associated with BCR (OR 2.12, p<0.01). As compared to men who had Grade Group 1 disease, men with Grade Groups 2-4 were also significantly associated with BCR (OR 1.64, 2.53, 3.84; p<0.01 for all). Prior AS was not associated with increased odds of BCR (OR 0.67, p=0.08). Similar findings were seen when restricted to a non-positive margin of resection with the AS cohort not associated with BCR (OR 0.67, p=0.12, n=4,114).
Conclusions: Our analysis demonstrates that prior AS is not associated with worse oncological outcomes following RP. While further study is required, the current data provide reassurance about the safety of AS, including among men with disease progression who undergo delayed RP.
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