title: Pathological outcomes of Japanese men eligible for active surveillance after radical prostatectomy.
abstract: BACKGROUND
  The aim of this study was to analyze the pathological features of prostatectomy specimens from patients with low-risk prostate cancer eligible for active surveillance (AS) and evaluate preoperative data suitable for predicting upstaged (≥pT3) or upgraded disease (Gleason score of ≥7), defined as 'reclassification'.
  
  
  METHODS
  A retrospective analysis of 521 consecutive radical prostatectomy procedures (January 2005 through to December 2011) performed at our institution without neoadjuvant hormonal therapy was performed. Eighty-four patients fulfilled the following criteria-clinical T1 or T2 disease, prostate-specific antigen (PSA) level of ≤10 ng/ml, one or two positive biopsies, and Gleason score of <7. Clinicopathological features at diagnosis were compared between patients with and without reclassification after radical prostatectomy.
  
  
  RESULTS
  Forty of 84 patients (47.6 %) had a Gleason score of ≥7, and 8 (9.5 %) had upstaged disease (≥pT3). Seven patients with upstaged disease also showed upgraded reclassification. Two patients with reclassification showed biochemical recurrence at 59 and 89 months after surgery, respectively. Preoperative parameters evaluated included age, PSA level, PSA density (PSAD), clinical T stage, and number and percentage of positive prostate cores. Among 82 patients with complete data, univariate analysis showed that PSAD (ng/ml(2)) was a significant parameter to discriminate patients with reclassified disease and those without reclassified disease (p < 0.001). Multivariate analysis revealed that PSAD was the only independent variable to predict disease with reclassification (p = 0.006).
  
  
  CONCLUSIONS
  Preoperative PSAD may be a good indicator for selecting patients eligible for AS in the Japanese population.
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 5731191, Japan, takahi@kuhp.kyoto-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Inui
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Oguchi
authors.forename: Gen
authors.initials: G
authors.lastname: Kawa
authors.forename: Motohiko
authors.initials: M
authors.lastname: Sugi
authors.forename: Chisato
authors.initials: C
authors.lastname: Ohe
authors.forename: Chika
authors.initials: C
authors.lastname: Miyasaka
authors.forename: Yorika
authors.initials: Y
authors.lastname: Nakano
authors.forename: Noriko
authors.initials: N
authors.lastname: Sakaida
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Uemura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
references.citation: Eur Urol. 2012 Aug;62(2):195-200
references.pmid: 22342775
references.citation: J Urol. 2010 May;183(5):1779-85
references.pmid: 20304433
references.citation: J Clin Oncol. 2010 Jan 1;28(1):126-31
references.pmid: 19917860
references.citation: BJU Int. 2007 Apr;99(4):786-93
references.pmid: 17223922
references.citation: Jpn J Clin Oncol. 2008 Feb;38(2):122-8
references.pmid: 18272471
references.citation: Prostate Cancer Prostatic Dis. 2011 Mar;14(1):53-7
references.pmid: 20938463
references.citation: Eur Urol. 2011 Aug;60(2):291-303
references.pmid: 21601982
references.citation: J Urol. 2010 Oct;184(4):1322-7
references.pmid: 20723940
references.citation: Urology. 2012 Sep;80(3):656-60
references.pmid: 22770616
references.citation: JAMA. 1994 Feb 2;271(5):368-74
references.pmid: 7506797
references.citation: Eur Urol. 2012 Dec;62(6):976-83
references.pmid: 22698574
references.citation: J Urol. 2011 Jun;185(6):2143-7
references.pmid: 21496847
references.citation: BJU Int. 2012 Dec;110(11):1672-7
references.pmid: 22928973
references.citation: Cancer. 2008 Jun 15;112(12):2664-70
references.pmid: 18433013
references.citation: BJU Int. 2011 Dec;108(11):1739-42
references.pmid: 21736692
references.citation: Eur Urol. 2008 Dec;54(6):1297-305
references.pmid: 18342430