title: Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study.
abstract: OBJECTIVE
  To evaluate the pathologic features of surgical specimens after radical prostatectomy in patients with low-risk prostate cancer fulfilling the strictest pathologic selection criteria for active surveillance.
  
  
  METHODS
  Retrospective analysis of 10 785 consecutive radical prostatectomy performed in 10 university hospitals (January 2003 through December 2008). A total of 919 patients fulfilled the following unique and very stringent criteria: T1c, prostate-specific antigen (PSA) <10 ng/mL, a single positive biopsy, tumor length <3 mm, and Gleason score <7. Clinico-biologic and pathologic data at diagnosis and after radical prostatectomy, prostatic and tumor volume, pathologic Gleason score and stage, positive surgical margins, insignificant prostate cancer, and PSA outcomes were recorded.
  
  
  RESULTS
  Median age was 63 years. Mean prebiopsy PSA level was 6.2 ng/mL. At radical prostatectomy, Gleason score was upgraded in 34% of patients, including 1.2% Gleason score 8-9. Pathologic stages were pT2 in 87.3%, pT3 in 11.1%, and pT4 in 1.4% of cases. Extraprostatic extension was found in 12.5%. Only 26% of patients had "insignificant" tumors. Biochemical recurrence-free survival at 5 years was 92.3%. There was no significant difference in survival between patients with "significant" and "insignificant" tumors (90.1% vs 93.4%; P = .06).
  
  
  CONCLUSIONS
  Despite of a stringent selection of patients with low-risk prostate cancer, active surveillance definition included a significant proportion of patients with upstaged (about 12%) and upgraded (about one-third) disease at diagnosis. Only a quarter of active surveillance patients have a pathologically confirmed "insignificant" cancer.
authors: Urology Department, Rangueil University Hospital, Toulouse, France. jbbeauval@gmail.com
authors: Jean-Baptiste
authors: JB
authors: Beauval
authors: Guillaume
authors: G
authors: Ploussard
authors: Michel
authors: M
authors: Soulié
authors: Christian
authors: C
authors: Pfister
authors: Simon
authors: S
authors: Van Agt
authors: Sébastien
authors: S
authors: Vincendeau
authors: Sébastien
authors: S
authors: Larue
authors: Jérome
authors: J
authors: Rigaud
authors: Nicolas
authors: N
authors: Gaschignard
authors: Morgan
authors: M
authors: Rouprêt
authors: Sarah
authors: S
authors: Drouin
authors: Mickael
authors: M
authors: Peyromaure
authors: Jean Alexandre
authors: JA
authors: Long
authors: Francois
authors: F
authors: Iborra
authors: Guy
authors: G
authors: Vallancien
authors: Francois
authors: F
authors: Rozet
authors: Laurent
authors: L
authors: Salomon
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D057832:Watchful Waiting