title: Potential consequences of low biopsy core number in selection of patients with prostate cancer for current active surveillance protocols.
abstract: OBJECTIVE
  To compare the performance of the Epstein criteria and the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria in the identification of patients eligible for active surveillance (AS) but treated with radical prostatectomy.
  
  
  METHODS
  We evaluated the baseline characteristics, final pathologic examination, and prostate-specific antigen follow-up (median 43 months, range 1-118) in a series of 492 consecutive patients with prostate cancer managed by radical prostatectomy without AS from 2001 to 2011 at a single institution. Using the postoperative histologic findings, multivariate analysis was used to identify the preoperative predictors of unfavorable AS selection (Gleason score >6 and/or greater than stage pT2c on the final pathologic examination). Biochemical recurrence-free survival was compared between favorably and unfavorably selected patients.
  
  
  RESULTS
  Applying the Epstein and PRIAS criteria, 29.2% and 32.2% of the patients had Gleason score >6 or stage pT3 on final pathologic examination, respectively. After a median follow-up of 35.5 and 38 months, 4.2% and 4.3% of patients developed biochemical recurrence in the Epstein and PRIAS criteria groups, respectively. Patients with unfavorable selection had significantly worse biochemical recurrence-free survival than patients with favorable selection (P <.05). Although the median biopsy core number was 8, a biopsy core number <9 was a significant and independent predictor for unfavorable preoperative AS selection in the PRIAS group.
  
  
  CONCLUSIONS
  We found a non-negligible risk of underestimating unfavorable cancer in patients theoretically qualifying for AS in our cohort. The current use of a sufficient number of biopsy cores might improve the selection process for AS.
authors: Department of Urology, University Hospital Basel, Basel, Switzerland. muellerge@uhbs.ch
authors: Georg
authors: G
authors: Müller
authors: Gernot
authors: G
authors: Bonkat
authors: Malte
authors: M
authors: Rieken
authors: Stephen F
authors: SF
authors: Wyler
authors: Lukas
authors: L
authors: Bubendorf
authors: Heike
authors: H
authors: Püschel
authors: Thomas C
authors: TC
authors: Gasser
authors: Alexander
authors: A
authors: Bachmann
authors: Cyrill A
authors: CA
authors: Rentsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*