title: Currently used criteria for active surveillance in men with low-risk prostate cancer: an analysis of pathologic features.
abstract: BACKGROUND
  Active surveillance (AS) represents a treatment option for select patients with low-risk, organ-confined prostate cancer (PCa). In this report, the authors addressed the rates of misclassification associated with the use of 5 different clinical criteria for AS. Misclassification was defined as the presence of either nonorgan-confined disease or high-grade PCa.
  
  
  METHODS
  Between 1992 and 2007, 4885 patients underwent radical prostatectomy (RP) at 1 of 2 European academic centers, and the patients were identified who fulfilled the criteria for AS according to 5 different investigational groups (Hardie et al, Roemeling et al, Choo et al, Klotz, and D'Amico and Coleman). Statistics targeted the rates of misclassification for each of the 5 definitions.
  
  
  RESULTS
  Four thousand three hundred eight patients, 4047 patients, 3993 patients, 2455 patients, and 2345 patients fulfilled the AS criteria of Hardie et al, Roemeling et al, Choo et al, Klotz, and D'Amico and Coleman, respectively. Extracapsular extension was reported in 13.5% to 26% of patients, and seminal vesicle invasion was reported in 2.9% to 8.2% of patients. When PCa with Gleason scores from 8 to 10 at RP was considered high grade, the misclassification rates were 27%, 25%, 25%, 15%, and 14% for the 5 studies, respectively. Conversely, when PCa with Gleason scores from 7 to 10 was considered high grade, the misclassification rates increased to 56%, 55%, 45%, 42%, and 39%, respectively.
  
  
  CONCLUSIONS
  The currently available AS criteria are limited by a high rate of misclassification. The use of more selective AS criteria may reduce the rate of misclassification but also may reduce significantly the percentage of patients who may be considered for AS.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Andreas
authors.initials: A
authors.lastname: Erbersdobler
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D012306:Risk; D018571:Sentinel Surveillance
chemical_list: D017430:Prostate-Specific Antigen