Does time spent on active surveillance adversely affect the pathologic and oncologic outcomes in patients undergoing delayed radical prostatectomy

PURPOSE: Pathologic and oncologic outcomes of delayed radical prostatectomy (RP) following prostate cancer active surveillance (AS) are not well established. To determine the pathologic and oncologic outcomes of favorable risk, Grade Group (GG) =1, prostate cancer (PCa) managed with AS and progressing to RP for clinically significant (CS) PCa (GG >/= 2). MATERIALS AND METHODS: Between 1992-2015, 170 men with favorable-risk PCa underwent delayed RP for CSPCa (ASRP) at the Princess Margaret Cancer Centre. Pathologic and oncologic outcomes of the ASRP cohort were compared with a matched cohort treated with upfront RP (n=405) immediately before surgery. Biochemical recurrence (BCR) free survival, overall survival (OS), and cancer-specific survival (CSS) were compared. We examined the association between delayed RP and adverse pathology at RP and BCR using Logistic and Cox regression analyses, respectively. RESULTS: The median time spent on AS before RP was 31.0 months. At RP, pT3 (extraprostatic extension, seminal vesicle invasion), positive surgical margin, and pN1rates were comparable between the two cohorts. Median follow-up after RP was 5.6 years. The five-year BCR-free survival rate in the ASRP cohort and upfront RP cohort were 85.8% and 82.4%, respectively (p=0.38). OS, CSS were comparable between the two groups. Delayed RP was not associated with adverse pathologic outcomes and BCR on regression analyses. CONCLUSIONS: Curative-intent RP after a period of AS results in excellent pathologic and oncologic outcomes at five years. A period of AS does not result in inferior outcomes compared to patients with similar risk characteristics undergoing upfront RP.