title: Low prostate-specific antigen and no Gleason score upgrade despite more extensive cancer during active surveillance predicts insignificant prostate cancer at radical prostatectomy.
abstract: OBJECTIVE
  To identify parameters that predict insignificant prostate cancer in 67 radical prostatectomies after biopsy reclassification to worse disease on active surveillance.
  
  
  METHODS
  Parameters evaluated at diagnosis and at biopsy reclassification included serum prostate-specific antigen, prostate-specific antigen density, number of positive cores, maximum percent involvement of cancer per core, and any interval negative biopsies. Gleason upgrading at biopsy reclassification was also assessed to predict insignificant cancer.
  
  
  RESULTS
  Mean time between diagnosis and radical prostatectomies was 30.3 months with a median of 3 biopsies (range 2-9). Nineteen of 67 (28.4%) had clinically insignificant cancer at radical prostatectomy. In the entire group, there were no variables significantly associated with insignificant cancer at radical prostatectomy. In a subgroup analysis of 37 patients without Gleason pattern 4/5 at biopsy reclassification, 16/37 (43.2%) showed insignificant cancer at radical prostatectomy. In this subgroup, prostate-specific antigen at diagnosis was significantly lower in men with insignificant cancer (3.7 ng/mL) vs significant cancer (5.4 ng/mL) (P = .0005). With prostate-specific antigen <4 ng/mL at diagnosis or at biopsy reclassification, 12/13 (92.3%) men showed insignificant cancer, whereas only 4/24 (16.7%) men with prostate-specific antigen >4 ng/mL both at diagnosis and at biopsy reclassification showed insignificant cancer.
  
  
  CONCLUSIONS
  Most men with biopsy reclassification while on active surveillance have significant disease at radical prostatectomy, justifying their treatment. Low prostate-specific antigen at diagnosis or at biopsy reclassification can predict a high probability of insignificant cancer in the absence of Gleason pattern 4/5 on biopsy. These men may be candidates for continuing active surveillance.
authors.affiliation: Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Jeong S
authors.initials: JS
authors.lastname: Han
authors.forename: Adam D
authors.initials: AD
authors.lastname: Toll
authors.forename: Ali
authors.initials: A
authors.lastname: Amin
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Patricia
authors.initials: P
authors.lastname: Landis
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*
chemical_list: D017430:Prostate-Specific Antigen