title: Eligibility for active surveillance and pathological outcomes for men undergoing radical prostatectomy in a large, community based cohort.
abstract: OBJECTIVE
  We analyzed competing active surveillance criteria in men who underwent radical prostatectomy in relation to outcome data in a large, community based cohort.
  
  
  METHODS
  We identified all men from the CaPSURE database who underwent radical prostatectomy from 1999 to 2007 and met inclusion criteria for the stringent prospective University of California-San Francisco and Johns Hopkins active surveillance protocols. Rates of pathological upgrading, up staging and biochemical recurrence were compared.
  
  
  RESULTS
  We identified 2,837 men who underwent radical prostatectomy and had complete pathological and followup data available. Of these men 1,375 and 125 met University of California-San Francisco and Johns Hopkins criteria, respectively. When comparing men who met the 2 sets of criteria vs those who met University of California-San Francisco criteria only, there were no significant differences in the rate of upgrading (20% vs 27%, p = 0.07) and up staging (6% vs 8%, p = 0.39) at radical prostatectomy. At a median 36-month followup 5-year biochemical recurrence-free estimates were similar at 92% in men who met the 2 sets of criteria and 90% in those who met the University of California-San Francisco definition only. On multivariate analysis upgrading to 7 or greater (HR 2.2, 95% CI 1.2-4.2), up staging (HR 3.5, 95% CI 1.3-9.3), and upgrading plus up staging (HR 6.9, 95% CI 3.3-14.5) were associated with a higher risk of biochemical recurrence in patients who met University of California-San Francisco criteria.
  
  
  CONCLUSIONS
  Men who met enrollment criteria for the 2 active surveillance protocols had a similar rate of upgrading, up staging and 5-year biochemical recurrence-free rates after radical prostatectomy. Further comparison between current protocols is warranted to establish universal inclusion criteria.
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Davies
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011159:Population Surveillance / Q000379:methods*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome