Impact of adherence to criteria on oncological outcomes of radical prostatectomy in patients opting for active surveillance: data from the PRIAS-JAPAN study

Author:

Tohi Yoichiro1ORCID,Kato Takuma1,Miyakawa Jimpei2,Matsumoto Ryuji3,Sasaki Hiroshi4,Mitsuzuka Koji5,Inokuchi Junichi6,Matsumura Masafumi7,Yokomizo Akira8,Kinoshita Hidefumi9,Hara Isao10,Kawamura Norihiko11,Hashimoto Kohei12ORCID,Inoue Masaharu13,Teishima Jun14,Kanno Hidenori15,Fukuhara Hiroshi16,Maruyama Satoru17,Sakamoto Shinichi18,Saito Toshihiro19,Kakehi Yoshiyuki1,Sugimoto Mikio1ORCID

Affiliation:

1. Department of Urology , Faculty of Medicine, Kagawa University, Kagawa, Japan

2. Department of Urology , Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

3. Department of Renal and Genito-Urinary Surgery , Graduate School of Medicine, Hokkaido University, Hokkaido, Japan

4. Department of Urology , Jikei University School of Medicine, Tokyo, Japan

5. Department of Urology , Tohoku University Graduate School of Medicine, Miyagi, Japan

6. Department of Urology , Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

7. Department of Urology , National Hospital Organization Shikoku Cancer Center, Ehime, Japan

8. Division of Urology , Harasanshin Hospital, Fukuoka, Japan

9. Department of Urology and Andrology , General Medical Center, Kansai Medical University, Osaka, Japan

10. Department of Urology , Wakayama Medical University, Wakayama, Japan

11. Department of Urology , Osaka International Cancer Institute, Osaka, Japan

12. Department of Urology , Sapporo Medical University School of Medicine, Hokkaido, Japan

13. Department of Urology , Saitama Cancer Center, Saitama, Japan

14. Department of Urology , Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan

15. Department of Urology , Yamagata University, Yamagata, Japan

16. Department of Urology , Kyorin University School of Medicine, Tokyo, Japan

17. Department of Urology , Hokkaido Cancer Center, Hokkaido, Japan

18. Department of Urology , Chiba University Graduate School of Medicine, Chiba, Japan

19. Department of Urology , Niigata Cancer Center Hospital, Niigata, Japan

Abstract

Abstract Objectives This study aimed to evaluate whether oncological outcomes of radical prostatectomy differ depending on adherence to the criteria in patients who opt for active surveillance. Materials and methods We retrospectively reviewed the data of 1035 patients enrolled in a prospective cohort of the PRIAS-JAPAN study. After applying the exclusion criteria, 136 of 162 patients were analyzed. Triggers for radical prostatectomy due to pathological reclassification on repeat biopsy were defined as on-criteria. Off-criteria triggers were defined as those other than on-criteria triggers. Unfavorable pathology on radical prostatectomy was defined as pathological ≥T3, ≥GS 4 + 3 and pathological N positivity. We compared the pathological findings on radical prostatectomy and prostate-specific antigen recurrence-free survival between the two groups. The off-criteria group included 35 patients (25.7%), half of whom received radical prostatectomy within 35 months. Results There were significant differences in median prostate-specific antigen before radical prostatectomy between the on-criteria and off-criteria groups (6.1 vs. 8.3 ng/ml, P = 0.007). The percentage of unfavorable pathologies on radical prostatectomy was lower in the off-criteria group than that in the on-criteria group (40.6 vs. 31.4%); however, the differences were not statistically significant (P = 0.421). No significant difference in prostate-specific antigen recurrence-free survival was observed between the groups during the postoperative follow-up period (median: 36 months) (log-rank P = 0.828). Conclusions Half of the off-criteria patients underwent radical prostatectomy within 3 years of beginning active surveillance, and their pathological findings were not worse than those of the on-criteria patients.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology,General Medicine

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