title: The presence of high-grade prostatic intraepithelial neoplasia or atypia on prostate biopsy does not adversely affect prostatectomy outcomes for patients otherwise eligible for active surveillance.
abstract: OBJECTIVE
  To investigate if the presence of concomitant high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on biopsy increases the risk of occult adverse pathology in patients otherwise suitable for active surveillance (AS).
  
  
  METHODS
  Patients with D'Amico low-risk prostate cancer on ≥ 10-core biopsy who underwent radical prostatectomy at our academic center were evaluated for eligibility for AS by either Epstein criteria or Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Prostatectomy specimens of patients eligible for AS were compared to determine if the presence of clinical HGPIN or ASAP affected the primary outcomes of pathologic upstaging and Gleason score upgrading.
  
  
  RESULTS
  Of 553 patients with low-risk prostate cancer, 400 patients (72.3%) met the MSKCC criteria, whereas only 170 patients (30.7%) met the Epstein criteria. HGPIN was present in approximately 32%, and ASAP in approximately 12%, of each AS cohort. On univariate and multivariate analyses, HGPIN and ASAP had no impact on the rate of upgrading and upstaging in either Epstein or MSKCC AS-eligible patients. Furthermore, the presence of HGPIN and ASAP had no impact on the 5-year biochemical recurrence-free survival.
  
  
  CONCLUSIONS
  The presence of HGPIN or ASAP does not increase the risk of upgrading, upstaging, or adverse pathology at the time of prostatectomy for patients who meet the AS criteria. If otherwise suitable, HGPIN and ASAP should not impact the decision to choose AS. However, analysis of prospective AS trials is required to determine if HGPIN or ASAP impacts tumor progression once on AS.
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA. Electronic address: Eugene.pietzak@uphs.upenn.edu.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Pietzak
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Abdo E
authors.initials: AE
authors.lastname: Kabarriti
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Mucksavage
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bavaria
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Keith
authors.initials: K
authors.lastname: Van Arsdalen
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wein
authors.affiliation: Division of Urology, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Guzzo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality; D019048:Prostatic Intraepithelial Neoplasia / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D057832:Watchful Waiting