title: Comparison of pathological outcomes of active surveillance candidates who underwent radical prostatectomy using contemporary protocols at a high-volume Korean center.
abstract: OBJECTIVE
  We compared contemporary active surveillance protocols based on pathological outcomes in patients who underwent radical prostatectomy.
  
  
  METHODS
  We identified the experimental cohort from prostate cancer patients who underwent radical prostatectomy between 2001 and 2011, and who met the inclusion criteria of five published active surveillance protocols, namely Johns Hopkins Medical Institution, University of California at San Francisco, Memorial Sloan-Kettering Cancer Center, University of Miami and Prostate Cancer Research International: Active Surveillance. To compare each protocol, we evaluated the pathological outcomes and calculated the sensitivity, specificity and accuracy for each protocol according to the proportion of organ-confined Gleason≤6 disease.
  
  
  RESULTS
  Overall, 376 patients met the inclusion criteria of the active surveillance protocols with 61, 325, 222, 212 and 206 patients meeting the criteria of the Johns Hopkins Medical Institution, University of California at San Francisco, Memorial Sloan-Kettering Cancer Center, University of Miami and Prostate Cancer Research International: Active Surveillance protocols, respectively. The sensitivity and specificity values of the five protocols, respectively, were 0.199 and 0.882 in Johns Hopkins Medical Institution, 0.855 and 0.124 in University of California at San Francisco, 0.638 and 0.468 in Memorial Sloan-Kettering Cancer Center, 0.599 and 0.479 in University of Miami, and 0.609 and 0.527 in Prostate Cancer Research International: Active Surveillance. In terms of both the sensitivity and specificity, Prostate Cancer Research International: Active Surveillance was the most balanced protocol. In addition, Prostate Cancer Research International: Active Surveillance showed a more accurate performance for favourable pathological outcomes than the others. However, using the area under the curve to compare the discriminative ability of each protocol, there were no statistically significant differences.
  
  
  CONCLUSIONS
  The contemporary active surveillance protocols showed similar pathological characteristics in patients who had undergone radical prostatectomy. However, we concluded that the Prostate Cancer Research International: Active Surveillance protocol would be most helpful to Korean populations in choosing candidates for active surveillance considering the balance between sensitivity and specificity and the accuracy of diagnosis.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University Health System, PO BOX 1217, Seoul, Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Lee
authors.forename: Ha Bum
authors.initials: HB
authors.lastname: Jung
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Hong
authors.forename: Seung Choul
authors.initials: SC
authors.lastname: Yang
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D010338:Pathology, Clinical / Q000379:methods* / Q000592:standards; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic / Q000592:standards; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D056910:Republic of Korea