Pathological outcomes of Hong Kong Chinese patients with low risk prostate cancer eligible for active surveillance undergoing radical prostatectomy: comparison of six different protocols

Abstract

Objective: To study the outcomes of local Chinese patients eligible for active surveillance (AS) undergoing radical prostatectomy using different AS protocols.

Patients & Methods: From 1998 to 2012, 287 patients underwent radical prostatectomy for prostate cancer. Their pathological data were reviewed. Six different AS protocols were applied to the cohort with patients stratified in six different manners. Comparative analyses of the probabilities of missing unfavorable pathological outcomes were compared.

Results: Extracapsular extension, seminal vesicle invasion, pathological T3 disease and upgrade of Gleason's score were present in 3.3%–17.2%, 1.6–3.4%, 3.3–19.2% and 20.6–34.5% respectively in the protocols. Protocol that considers PSA and Gleason score only had significantly higher rates of missing extracapsular extension and upgrading of pathological T stage.

Conclusion: AS protocol based on PSA and Gleason's score alone may miss higher risk disease. Before widespread use of the various AS protocols, careful analysis of their performance in the local population is advised to minimize rate of missing unfavorable diseases.