title: Are active surveillance criteria sufficient for predicting advanced stage prostate cancer patients?
abstract: OBJECTIVE
  To examine the treatment outcomes of the prostate cancer (PCa) patients treated by radical prostatectomy (RP) who could be good candidates for active surveillance (AS) and test the confidence and reliability of the AS criterias for predicting advanced stage disease (RP Gleason score≥7 or Pathological stage T3).
  
  
  METHODS
  Between 2005 and 2012 the records of the 401 patients who underwent RP with a diagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. The inclusion criteria were as follows; clinical stage T2a or less, PSA<10ng/ml, 2 or fewer cores involved with cancer, no single core with 50% or greater maximum involvement of cancer, and no Gleason grade greater than 3 in the specimen.
  
  
  RESULTS
  Univariate analyzes revealed that patients with advanced stage disease have higher prostate specific antigen density (PSAD), higher maximum percent (max%) in positive cores and higher RP tumor volumes. In multivariate analyzes PSAD, max% in positive cores and RP tumor volumes were statistically significant determinants for advanced stage disease. ROC analyzes revealed that the RP tumor volume is a good test on advanced stage disease.
  
  
  CONCLUSIONS
  Decreasing the cutoff values for PSAD and max% in positive cores should be considered for AS inclusion criteria. If we could calculate the tumor volume before RP, we can minimize the treatment failures (over or undertreatment) of PCa. Perhaps new biopsy protocols, tissue biomarkers, and molecular imaging technology may refine AS criteria.
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Urology, Izmir, Turquía. Electronic address: sakirongun@hotmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Ongun
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Urology, Izmir, Turquía.
authors.forename: S
authors.initials: S
authors.lastname: Celik
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turquía.
authors.forename: G
authors.initials: G
authors.lastname: Gül-Niflioglu
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Urology, Izmir, Turquía.
authors.forename: G
authors.initials: G
authors.lastname: Aslan
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turquía.
authors.forename: B
authors.initials: B
authors.lastname: Tuna
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Urology, Izmir, Turquía.
authors.forename: U
authors.initials: U
authors.lastname: Mungan
authors.affiliation: Hacettepe University School of Medicine, Department of Public Health, Ankara, Turquía.
authors.forename: S
authors.initials: S
authors.lastname: Uner
authors.affiliation: Dokuz Eylul University School of Medicine, Department of Pathology, Izmir, Turquía.
authors.forename: K
authors.initials: K
authors.lastname: Yörükoğlu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
keywords: Carga tumoral; Estadificación del cáncer; Neoplasias de próstata; Neoplasm staging; Prostatectomy; Prostatectomía; Prostatic neoplasms; Tumor burden