Higher rates of upgrading and upstaging in older patients undergoing radical prostatectomy and qualifying for active surveillance


  • J.B. and A.M. contributed equally to this work



  • To determine pathological and oncological outcomes of patients diagnosed with low-risk prostate cancer in two age cohorts who underwent radical prostatectomy (RP) and qualified for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, as AS for low-risk prostate cancer represents an acceptable management strategy especially for older patients.

Patients and Methods

  • In all, 320 patients aged ≥65 years who underwent RP and were eligible for AS according to PRIAS criteria were propensity score matched 1:1 to patients aged <65 years.
  • Patient characteristics were compared with chi-square, Kruskal–Wallis, and one-way anova tests. Predictors of RP pathological upgrading or upstaging were analysed using logistic regression.
  • Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Predictors of RFS were analysed within Cox regression models.


  • Pathological upgrading and upstaging were significantly higher among older (≥65 years) vs younger (<65 years) patients (53.1% vs 44.1% and 12.2% vs 7.2%, respectively).
  • Higher prostate-specific antigen levels and increasing age were independent predictors of upgrading among patients aged <65 years.
  • There were no differences in RFS or OS between the two age groups.
  • Positive surgical margin status was the only independent predictor of shorter RFS.


  • Patients aged ≥65 years who are eligible for AS by PRIAS criteria have a higher risk of being upgraded and upstaged at RP than those aged <65 years.
  • These findings should be taken into consideration when discussing treatment options for patients diagnosed with prostate cancer.