I get emails from Uro today, one caught my eye today and makes me rethink AS a bit. You have to sign up to see the text but I'll cut/paste the high points here.
Link for the guys who are/want to sign upwww.urotoday.com/index.php?option=com_jentlacontent&view=enhanced&id=LkU6QkVIWS5GVk4zQ1AtOypYLkBgCmAK&Itemid=57
Most of the abstract for those who just want the meat.The data of patients who underwent a radical prostatectomy at our institution between 1998 and 2010 were reviewed. We only included the patients that met the usual criteria for active surveillance: clinical stage T1-2a tumor, PSA ≤ 10ng/mL, biopsy Gleason sum inferior or equal to 6 with no pattern of grade 4 or 5, cancer involvement inferior or equal to two biopsy cores, inferior to 3mm of malignant tissue in each positive biopsy core. From them, only those who were diagnosed from a second line biopsies cores were included for further analysis.
Overall, 48 patient who met the "SURACAP" criteria had a laparoscopic radical prostatectomy at out institution. Mean age was 65.4 years. The mean preoperative PSA was 6.1ng/mL. Clinical stage of the tumor was T1c in 95% of patients and T2a in 5%. Biopsy Gleason score was 6(3+3) in 100%. Pathological analysis of the surgical specimen showed that 19% of patients had a seminal vesicle invasion or an extracapsular extension. The Gleason score of the pathological specimen was 6 (3 +3) in 57% of patients, 7 (3 +4) in 38% and 8 (4 +4) in 5% of patients. The Gleason score upgrading was 43% of patients.
In our experience, 19% of patients who meet the criteria for active surveillance show an extracapsular extension or a seminal vesicle invasion on pathological analysis. Active surveillance is still under evaluation.
I never was even close to AS but for someone thinking of it, WOW.