title: Predictive models for worsening prognosis in potential candidates for active surveillance of presumed low-risk prostate cancer.
abstract: OBJECTIVE
  Low-risk prostate cancer patients clinically eligible for active surveillance can also be managed surgically. We evaluated the pathologic outcomes for this cohort that was treated by radical prostatectomy and devised nomograms to predict patients at risk of upgrading and/or upstaging.
  
  
  METHODS
  Seven hundred and fifty patients treated by radical prostatectomy from Jan 2005 to the present fulfilled conventional active surveillance criteria and formed the study cohort. Preoperative data on standard clinicopathologic parameters were available. The radical prostatectomy specimens were graded and staged, and any upgrading to Gleason sum >6 or upstaging to ≥pT3 ('worsening prognosis') were noted. Multivariable logistic regression models were used to develop predictive nomograms.
  
  
  RESULTS
  Of the 750 patients, 303 (40.4%) patients were either upgraded or upstaged. Multivariable analysis found that preoperative PSA, number of positive cores, and prostate volume were significantly predictive of worsening prognosis and formed the nomogram criteria.
  
  
  CONCLUSIONS
  Of patients deemed eligible for active surveillance based on conventional criteria, 40.4% have worse prognostic factors after radical prostatectomy. Current active surveillance criteria may be too relaxed, and the use of nomograms which we have devised, may aid in counseling primary prostate cancer patients considering active surveillance as their therapy of choice.
authors.affiliation: Department of Urology, Lefrak Center of Robotic Surgery & Institute of Prostate Cancer, Weill Cornell Medical College, James Buchanan Brady Foundation, New York, NY 10065, USA.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Abhishek
authors.initials: A
authors.lastname: Srivastava
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Sonal
authors.initials: S
authors.lastname: Grover
authors.forename: Maria
authors.initials: M
authors.lastname: Shevchuk
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tewari
mesh_terms: D001707:Biopsy, Needle; D018450:Disease Progression; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods / Q000592:standards*; D049451:Nomograms; D018579:Patient Selection; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology