title: Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols.
abstract: BACKGROUND
  Although the rationale for active surveillance (AS) in patients with low-risk prostate cancer is well established, eligibility criteria vary significantly across different programs.
  
  
  OBJECTIVE
  To compare the ability of contemporary AS criteria to identify patients with certain pathologic tumor features based on the results of an extended transrectal prostate biopsy.
  
  
  METHODS
  The study cohort included 391 radical prostatectomy patients who had prostate cancer with Gleason scores ≤ 6 on transrectal biopsy with ≥ 10 cores.
  
  
  METHODS
  Radical prostatectomy without neoadjuvant treatment.
  
  
  METHODS
  We identified patients who fulfilled the inclusion criteria of five AS protocols including those of Epstein, Memorial Sloan-Kettering Cancer Center, Prostate Cancer Research International: Active Surveillance (PRIAS), University of California, San Francisco, and University of Miami (UM). We evaluated the ability of these criteria to predict three pathologic end points: insignificant disease defined using a classical and updated formulation, and organ-confined Gleason ≤ 6 prostate cancer. Measures of diagnostic accuracy and areas under the receiver operating curve were calculated for each protocol and compared.
  
  
  CONCLUSIONS
  A total of 75% of the patients met the inclusion criteria of at least one protocol; 23% were eligible for AS by all studied criteria. The PRIAS and UM criteria had the best balance between sensitivity and specificity for both definitions of insignificant prostate cancer and a higher discriminative ability for the end points than any criteria including patients with two or more positive cores. The Epstein criteria demonstrated high specificity but low sensitivity for all pathologic end points, and therefore the discriminative ability was not superior to those of other protocols.
  
  
  CONCLUSIONS
  Significant variations exist in the ability of contemporary AS criteria to predict pathologically insignificant prostate cancer at radical prostatectomy. These differences should be taken into account when making treatment choices in patients with low-risk prostate cancer.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA. viremashvili@med.miami.edu
authors.forename: Viacheslav
authors.initials: V
authors.lastname: Iremashvili
authors.forename: Lisét
authors.initials: L
authors.lastname: Pelaez
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Mercé
authors.initials: M
authors.lastname: Jorda
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Rosenberg
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D001706:Biopsy; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D004608:Eligibility Determination; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen