TOPLINE

Men with low- or intermediate-risk prostate cancer (PCa) who underwent radical prostatectomy after active surveillance had higher odds of adverse pathologic findings and a higher risk for postoperative PCa treatment than those who underwent radical prostatectomy within a year of diagnosis.

METHODOLOGY

• Researchers conducted a nationwide, population-based cohort study using data from the Norwegian Prostate Cancer Registry to identify men diagnosed with low- or intermediate-risk PCa from 2009 to 2022.
• Participants meeting eligibility were men aged 40-79 years, having adenocarcinoma histology, prostate-specific antigen (PSA) levels ≤ 20 ng/mL, clinical stage of T2b or lower, International Society of Urological Pathology (ISUP) grade group of 2 or less, Eastern Cooperative Oncology Group performance status of 1 or less, without metastases identified during diagnostic evaluation.
• A total of 1839 men underwent deferred radical prostatectomy after active surveillance (median time to surgery, 23 months) and 5767 underwent immediate radical prostatectomy (within a year of diagnosis); the overall active surveillance cohort comprised 8013 men.
• The researchers assessed adverse pathologic findings (defined as locally advanced disease of pT3 or higher, nodal metastasis, ISUP grade group of 3 or higher, or positive surgical margins) and post-radical prostatectomy PCa treatment (radiotherapy, androgen deprivation therapy, or combination approaches).
• The median follow-up duration was 5.6 years following the diagnosis of PCa.

TAKEAWAY

• Men who underwent deferred radical prostatectomy following active surveillance had significantly higher odds of adverse pathologic findings than those who underwent immediate surgery (adjusted odds ratio [aOR], 1.99; P < .001). 
• Preoperative high-risk disease predicted adverse pathologic outcomes among patients with delayed surgery (aOR, 4.5; P = .015).
• Men undergoing deferred radical prostatectomy had a higher risk for PCa treatment after radical prostatectomy (adjusted hazard ratio, 1.52; P < .001).
• No difference in 10-year PCa-specific survival emerged between deferred and immediate radical prostatectomy groups, documenting six PCa-related deaths among patients undergoing deferred prostatectomy and 27 among those undergoing immediate surgery.

IN PRACTICE

"The higher rates of adverse pathological findings and post-RP [radical prostatectomy] PCa treatment after deferred RP further support more risk-adapted surveillance, with intensified monitoring of men at higher risk of progression. Rising PSA levels during surveillance may warrant expedited urological assessment, even in the absence of histological progression," the researchers wrote.

"[The study] findings support improved risk-adapted follow-up during AS [active surveillance] to facilitate timely detection of progression and conversion to definitive treatment," they added.

SOURCE

The study was led by Ingrid Hannestad of the Institute of Clinical Medicine under the Faculty of Medicine at the University of Oslo in Oslo, Norway. It was published online on September 19 in the World Journal of Urology.

LIMITATIONS

Men receiving delayed radical prostatectomy might constitute a distinct subgroup among those undergoing active surveillance. Information regarding monitoring intensity, MRI results, subsequent biopsies, PSA kinetics, rationale for proceeding to radical prostatectomy, and postoperative PSA levels was lacking. Duration of follow-up was brief.

DISCLOSURES

No specific funding was reported for the study. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.