Does Preoperative Active Surveillance Elevate the Risk of Negative Pathological Outcomes or Subsequent Treatment for Prostate Cancer Following Radical Prostatectomy?

By
Ingrid Hannestad
Tor Åge Myklebust
Sophie D. Fosså
Stig Muller
Kirsti Aas
September 19, 2026

World Journal Of Urology

Overview

This study investigates the impact of preoperative active surveillance on surgical and oncological outcomes in men with prostate cancer undergoing radical prostatectomy, comparing adverse pathological findings and subsequent treatment needs between men who underwent deferred versus immediate surgery.

Background

Active surveillance (AS) is commonly utilized for men with low- and favorable intermediate-risk prostate cancer to avoid overtreatment. However, the implications of AS on surgical outcomes and the risk of subsequent treatments following radical prostatectomy (RP) remain uncertain.

Data Highlights

No numerical data or trial data were provided in the source material.

Key Findings

Deferred RP after AS may be associated with more frequent adverse pathological findings compared to immediate RP.
Some studies indicate that deferred RP could lead to poorer recurrence-free survival rates.
Despite adverse findings, a cohort study reported favorable oncological outcomes with a 10-year PSA relapse-free survival of 79.5% after deferred RP.
A Swedish study found that delayed RP was linked to a higher risk of salvage radiotherapy.
In the ProtecT trial, active monitoring resulted in higher rates of disease progression but similar prostate cancer-specific mortality compared to immediate treatment.

Clinical Implications

Clinicians should consider the potential for increased adverse pathological findings in patients undergoing deferred RP after AS.

Conclusion

The study discusses the outcomes of active surveillance prior to radical prostatectomy, particularly concerning adverse pathological findings and subsequent treatment requirements.