Adverse Pathological Findings at Radical Prostatectomy following Active Surveillance: Results from the Movember GAP3 Cohort

Cristina Marenghi*, Zhuyu Qiu, Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium, Jozien Helleman, Daan Nieboer, Josè Rubio-Briones, Peter R. Carroll, Lui Shiong Lee, Riccardo Valdagni, Paul C. Boutros, Nicola Nicolai

*Corresponding author for this work

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Abstract

Background: Little is known about the consequences of delaying radical prostatectomy (RP) after Active Surveillance (AS) according to stringent or wider entry criteria. We investigated the association between inclusion criteria and rates, and timing of adverse pathological findings (APFs) among patients in GAP3 cohorts. Methods: APFs (GG ≥ 3, pT ≥ 3, pN > 0 and positive surgical margins [R1]) were accounted for in very low-risk (VLR: grade group [GG] 1, cT1, positive cores < 3, PSA < 10 ng/mL, PSA density [PSAD] < 0.15 ng/mL/cm3) and low-risk (LR: GG1, cT1-2, PSA ≤ 10 ng/mL) patients undergoing subsequent RP. The Kaplan–Meier method and log–rank test analyzed APF-free survival. Stratified mixed effects models analyzed association. Results: Out of 21,169 patients on AS, 1742 (VLR: 721; LR: 1021) underwent delayed RP. Most (60.8%) did not have APFs. APFs occurred more frequently (44.6% vs. 31.7%; OR 1.54, p < 0.001) and earlier (median time: 40.3 vs. 62.6 months; p < 0.001) in LR patients, and consisted of pT ≥ 3 (OR 1.47, p = 0.013) or R1 (OR 1.80, p < 0.001), but not of GG ≥ 3 or node involvement. Age (OR 1.05, p < 0.001), PSAD (OR 23.21, p = 0.003), and number of positive cores (OR 1.16, p = 0.004) were independently associated with APFs. Conclusions: AS stands as a safe option for low-risk patients, and most do not have APFs at surgery. Wider entry criteria are associated with pT3 and R1. The prognostic implications remain uncertain.

Original languageEnglish
Article number3558
JournalCancers
Volume14
Issue number15
DOIs
Publication statusPublished - 22 Jul 2022

Bibliographical note

Funding Information:
This research was funded by the Movember Foundation (Australia), grant “GAP3” and the APC was funded by Fondazione IRCCS Istituto Nazionale dei Tumori (Milan, Italy).

Publisher Copyright:
© 2022 by the authors.

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