PURPOSE: We assessed oncologic outcomes at surgery in men with low-risk and very low-risk prostate cancer who were candidates for active surveillance. MATERIALS AND METHODS: In a prospectively-collected institutional database, we identified 7,486 subjects eligible for active surveillance who underwent radical retropubic prostatectomy. Candidates were designated as low-risk (LR; stage T1c/T2a, PSA ≤10 ng/ml, and Gleason score ≤6) or very low-risk (VLR; stage T1c, PSA density ≤0.15, Gleason score ≤6, ≤2 positive biopsy cores, ≤50% cancer involvement per core) based on pre-operative data. Adverse findings were Gleason score upgrade (GS≥7) and non organ-confined cancer (NOCC) on surgical pathology. The relative risk (RR) of adverse findings in men with LR and VLR disease were evaluated in a multivariable model using Poisson regression. RESULTS: 7,333 subjects met criteria for LR disease and 153 had VLR disease. The proportions of LR subjects found to have GS upgrade or non organ-confined cancer (NOCC) on final pathology were 21.8% and 23.1%, respectively. The corresponding values in VLR subjects were 13.1% and 8.5%. After adjusting for age, race, year of surgery, BMI, and PSA at diagnosis, the relative risk of GS upgrade in LR versus VLR disease was 1.89 (95% CI: 1.21-2.95). Relative risk of NOCC was 2.06 (95% CI: 1.19-3.57). CONCLUSION: Men with very low-risk prostate cancer had a significantly lower risk of adverse findings at surgery compared to those with low-risk disease. These data support the stratification of low risk cancer when selecting and counseling men who may be appropriate for active surveillance.