Will intermediate or high risks prostate cancer patients be mistakenly assigned into active surveillance programme? A retrospective review in Hong Kong

Abstract

OBJECTIVES Review the pathology of radical prostatectomy (RP) and investigate patients who were eligible for active surveillance (AS) on preoperative investigations and assess any pathological and radiological upstage of prostate cancer. METHODS A total of 158 patient underwent radical prostatectomy (RP) from September, 2011 to October, 2015 in Queen Mary Hospital were retrospectively reviewed. Baseline characteristics, transrectal ultrasound (TRUS) biopsy details, magnetic resonance imaging (MRI) and RP pathology were analysed. Univariate and multivariate analyses were used to identify any significant predictors of upstaged disease. RESULTS There were 48 patients fulfilled the Memorial Sloan Kettering Cancer Centre (MSKCC) criteria for AS. The accuracy of TRUS biopsy in predicting Gleason score and MRI in predicting extra-capsular disease were 52% and 95% respectively. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy of TRUS biopsy, MRI and combination of TRUS biopsy and MRI for laterality of disease are 16%, 100%, 100%, 5%, 19%; 23%,92%, 88%, 34%, 44% and 21%, 93%, 88%, 35%, 44% respectively. 46% of patients have upstaged disease with 15% were high risk prostate cancer. Age (HR 1.12, P = 0.025) and PSA density (HR 2.12, P = 0.017) were independent predictors on both univariate and multivariate analyses. CONCLUSION Both TRUS biopsy and MRI have a low positive predictive in low risks prostate cancer and significant upstaging in final pathology is common. Patients who were older and has high PSA density requires more detailed discussion on active surveillance and consider repeat biopsy before decide on the treatment of prostate cancer.