title: Is active surveillance a safe alternative in the management of localized prostate cancer? Pathological features of radical prostatectomy specimens in potential candidates for active surveillance.
abstract: OBJECTIVE
  Active surveillance (AS) has become an accepted alternative for patients with low risk prostate cancer. The purpose of AS is to defer definitive therapy in these patients to avoid treatment-related complications. Our aim was to determine the pathological features of the surgical specimen from potential AS candidates that underwent radical prostatectomy (RP).
  
  
  METHODS
  We retrospectively reviewed a group of patients submitted to RP who met criteria for AS: Gleason score (GS) ≤ 3+3 = 6, PSA ≤ 10ng/mL, T1c - T2a,< 1/3 of positive cores, < 50% of involvement in any core and PSA density < 0.15. We determined the concordance between GS in biopsy and RP specimen (RPS). Other pathological features of the RPS were also analyzed, including surgical margins, extracapsular extension, seminal vesicles and lymph node involvement.
  
  
  RESULTS
  We identified 167 patients subjected to RP that met the criteria for AS. Fifty two patients (31.1%) had a GS > 6 in the RPS (GS 7 n = 49; GS 8 n = 3). Extracapsular extension, seminal vesicle and lymph node involvement was found in 6.1%, 3.1% and 1.2% of the specimens, respectively.
  
  
  CONCLUSIONS
  In this study a significant proportion of potential candidates for AS showed features of aggressive and/or high-risk tumors in the RPS. Therefore, before considering a patient for an AS protocol, a proper and strict selection must be performed, and informed consent is crucial for these patients.
authors.affiliation: Department of Urology, Clinica Las Condes; Department of Urology, Hospital Militar, Santiago, Chile.
authors.forename: Z
authors.initials: Z
authors.lastname: Norman
authors.affiliation: Department of Urology, Hospital Militar, Santiago, Chile.
authors.forename: P
authors.initials: P
authors.lastname: Militza
authors.affiliation: Department of Urology, Hospital Militar, Santiago, Chile.
authors.forename: F
authors.initials: F
authors.lastname: Andres
authors.affiliation: Department of Urology, Clinica Las Condes, Santiago, Chile.
authors.forename: F
authors.initials: F
authors.lastname: Daniela
authors.affiliation: Department of Urology, University of Chile Clinical Hospital, Santiago, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Alejandro
authors.affiliation: Department of Urology, Clinica Las Condes, Santiago, Chile.
authors.forename: S
authors.initials: S
authors.lastname: Catherine
authors.affiliation: Department of Urology, San Borja Hospital, Santiago, Chile.
authors.forename: F
authors.initials: F
authors.lastname: Juan
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D019468:Disease Management; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen