Unfavourable final pathology rates in patients having radical prostatectomy after a period of active surveillance in the British Association of Urological Surgeons radical prostatectomy database
BAUS ePoster online library. Gallagher K. Jun 24, 2019; 259540; P5-10 Disclosure(s): Kevin Gallagher is in receipt of research funding from GlaxoSmithKline for a project unrelated to this one.
Mr. Kevin Gallagher
Mr. Kevin Gallagher
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Aim: To determine the rate of unfavourable disease at radical prostatectomy (RP) in patients previously on active surveillance (AS) and in those who had primary RP for low risk prostate cancer in the BAUS audit database.

Patients (2014-2017) were included if they had RP following a period of AS, or if they had RP as primary therapy for biopsy Gleason 3+3, PSA <10 cancer. Unfavourable pathology was defined as: all >/= pT3a or any Gleason >/= 8 or pT2 Gleason 7 with positive margin.

6309/25544 records met the inclusion criteria. 509 had incomplete data and were excluded, leaving 3240 previous AS and 2561 primary RP. Unfavourable pathology was 1478/3240 (45.6%) with previous AS and 849/2561 (33.2%) for primary RP (Table 1). The rate of unfavourable pathology trended to increase from 2014 to 2017 in patients with previous AS (from 42.4% to 47.2%, p=0.06) and decrease in those with primary RP (from 33.3% to 28.8%, p=0.10). The annual proportion of patients with previous AS vs primary RP for low risk disease increased 2014 to 2017 from 48.8% to 66.9%. We caution that the previous AS and primary RP groups are not directly comparable.

Conclusion: There is a significant rate of unfavourable pathology in patients who come to RP after a period of AS. Complacency in low risk prostate cancer should be avoided, AS should involve close monitoring and agreed thresholds for intervention. Unfavourable pathology rates at RP should be monitored.
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