Testing the most stringent criteria for selection of candidates for active surveillance in patients with low-risk prostate cancer.
OBJECTIVE
To test the ability of two of the most stringent criteria used to identify patients with low-risk prostate cancer suitable for active surveillance (AS) to correctly exclude patients with unfavourable prostate cancer characteristics.


METHODS
The study included 874 consecutive patients treated with radical prostatectomy (RP). We selected patients who could have been selected for AS according to the van den Bergh et al. and the Carter et al. criteria. We analysed the rates of advanced disease in these patients, defined as presence of either extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI) and Gleason sum of 8-10 or 7-10.


RESULTS
Of 874 patients, 85 (9.7%) and 61 (6.9%) patients, respectively, qualified for AS according to the tested criteria. Within the van den Bergh et al. candidates, 5.9, 1.2, 1.2 and 1.2% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10 at pathology. Within the Carter et al. candidates, 3.3, 0, 3.3 and 0% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10. The cumulative rate of unfavourable characteristics was 7.1 and 3.3%. The rate increased to 28.2 and 27.9%, respectively, when Gleason sum 7 was considered as an unfavourable prostate cancer.


CONCLUSIONS
The use of the strictest criteria for AS inclusion identified 7-10% of the men in our cohort of men undergoing RP, as men that would have been eligible for AS. Among this small proportion, between 3.3 and 7.1% of patients harboured unfavourable prostate cancer characteristics. The clinical implications of these misclassification rates remain to be determined.
Suardi
Nazareno
N
Department of Urology, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy. suardi.nazareno@hsr.it
Briganti
Alberto
A
Gallina
Andrea
A
Salonia
Andrea
A
Karakiewicz
Pierre I
PI
Capitanio
Umberto
U
Freschi
Massimo
M
Cestari
Andrea
A
Guazzoni
Giorgio
G
Rigatti
Patrizio
P
Montorsi
Francesco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment; D012669:Seminal Vesicles / Q000473:pathology
D017430:Prostate-Specific Antigen