Commentary on Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically: Louie-Johnsun M, Neill M, Treurnicht K, Jarmulowicz M, Eden C, Department of Laparoscopic Urology, Royal Surrey County Hospital

To study the outcomes of a contemporary cohort of patients referred from around the UK with low-risk prostate cancer consistent with the UK National Institute for Health and Clinical Excellence guidelines for active surveillance but who were treated with laparoscopic radical prostatectomy (LRP) in a single surgeon series. ,080 consecutive patients who underwent LRP between March 2000 and April 2008, 549 patients (51%) had low preoperative risk disease (PSA level > 10 ng/ml, clinical stage ≤ T2a, and biopsy Gleason score ≤ 6). The pathological outcomes of these 549 patients as well as a subgroup of 74 patients with preoperative prediction of “insignificant” disease were assessed. an age of the patients was 61 years, the mean (range) PSA level was 6.1 (1–9) ng/ml; 38% of patients were staged as cT2a. In all, 126 patients (23%) were upgraded on final pathology to Gleason score ≥ 7. In all, 29 patients (5%) had extraprostatic extension with seminal vesicle invasion in five (0.9%). Of the 74 patients with preoperative prediction of insignificant disease, 61% had significant disease with 16% upgraded to an intermediate-risk group. Overall, there were positive margins in 44 patients (8.0%), and biochemical failure occurred in 6 patients (1.1%) with a median follow-up of 28 months. s contemporary UK cohort of patients with apparently low- or favorable-risk prostate cancer, 23% will have higher grade disease than preoperatively predicted. Even though active surveillance is increasingly being recommended for managing low-risk localized prostate cancer, patients and their physicians need to be aware of the potential for harboring more significant disease.