Radical Prostatectomy Findings in Patients in Whom Active Surveillance of Prostate Cancer Fails

Amy S. Duffield, Thomas K. Lee, Hiroshi Miyamoto, H. Ballantine Carter, Jonathan I. Epstein

Research output: Contribution to journalArticlepeer-review

131 Scopus citations


Purpose: Little data are available on radical prostatectomy findings in men who experience disease progression following active surveillance. Materials and Methods: A total of 470 men in our active surveillance program underwent annual repeat needle biopsies to look for progression defined as any Gleason pattern grade 4/5, more than 50% cancer on any core or cancer in more than 2 cores. Slides were available for review in 48 of 51 radical prostatectomies with progression. Results: The average time between the first prostate biopsy and radical prostatectomy was 29.5 months (range 13 to 70), with 44% and 75% of the patients showing progression by the second and third biopsy, respectively. There were 31 (65%) organ confined cases, of which 25 (52%) were Gleason score 6. Of 48 cases 17 (35%) had extraprostatic extension, 3 had seminal vesicle/lymph node involvement and 7 (15%) had positive margins. Mean total tumor volume was 1.3 cm3 (range 0.02 to 10.8). Of the 48 tumors 13 (27%) were potentially clinically insignificant (organ confined, dominant nodule less than 0.5 cm3, no Gleason pattern 4/5) and 19% (5 of 26) of the radical prostatectomies with a dominant tumor nodule less than 0.5 cm3 demonstrated extraprostatic extension, 4 with Gleason pattern 4. All 10 tumors with a dominant nodule greater than 1 cm3 were located predominantly anteriorly. Conclusions: Most progression after active surveillance occurs 1 to 2 years after diagnosis suggesting undersampling of more aggressive tumor rather than progression of indolent tumor. Even with progression most tumors have favorable pathology (27% potentially insignificant). A small percentage of men have advanced stage disease (pT3b or N1). The anterior region should be sampled in men on active surveillance.

Original languageEnglish (US)
Pages (from-to)2274-2279
Number of pages6
JournalJournal of Urology
Issue number5
StatePublished - Nov 2009


  • prostatectomy
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology


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