title: Pathological upgrading and upstaging of patients eligible for active surveillance according to currently used protocols.
abstract: OBJECTIVE
  To investigate the ability of six contemporary active surveillance protocols to appropriately select active surveillance candidates among Korean men who underwent radical prostatectomy.
  
  
  METHODS
  Between January 2001 and December 2011, 1968 patients underwent radical prostatectomy for prostate cancer at Samsung Medical Center, Seoul, Korea. Patients met the criteria for active surveillance according to six currently used criteria, including those from the Johns Hopkins Hospital, the University of Toronto, the University of California at San Francisco, the Prospective Prostate Cancer Research International Active Surveillance, the University of Miami and the Memorial Sloan-Kettering Cancer Center. The rates of Gleason score upgrading, upstaging and misclassification at final pathology were assessed.
  
  
  RESULTS
  Among 1006 assessable patients, the percentage of men eligible for active surveillance varied from 13.5% to 38.5%, depending on the criteria used. The rates of upgrading ranged from 41.6% to 50.6%. Extracapsular extension was reported in 4.1% to 8.5% of patients, whereas seminal vesicle invasion was reported in 0.5% to 1.6% of patients. The upstaging rates according to the six active surveillance criteria varied from 4.5% to 9.3%, and the rates of misclassification varied from 44.5% to 54.8%.
  
  
  CONCLUSIONS
  Currently available active surveillance criteria might not be suitable in Korean patients with prostate cancer, as they have a high likelihood of underestimating cancer.
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Tae Heon
authors.initials: TH
authors.lastname: Kim
authors.forename: Hwang Gyun
authors.initials: HG
authors.lastname: Jeon
authors.forename: Seol Ho
authors.initials: SH
authors.lastname: Choo
authors.forename: Byong Chang
authors.initials: BC
authors.lastname: Jeong
authors.forename: Seong Il
authors.initials: SI
authors.lastname: Seo
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.forename: Han Yong
authors.initials: HY
authors.lastname: Choi
authors.forename: Hyun Moo
authors.initials: HM
authors.lastname: Lee
mesh_terms: D000368:Aged; D044466:Asian People; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D060787:Neoplasm Grading; D011159:Population Surveillance / Q000379:methods*; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D056910:Republic of Korea
keywords: active surveillance; clinical protocols; insignificant; prostate cancer; radical prostatectomy