title: Active Surveillance is an Appropriate Management Strategy for a Proportion of Men Diagnosed with Prostate Cancer by Prostate Specific Antigen Testing.
abstract: OBJECTIVE
  The purpose of this study was to determine the fraction of men who would qualify for active surveillance in a population based cohort diagnosed with prostate cancer. In those who qualified and subsequently underwent primary treatment with radical prostatectomy, we assessed the rate of upgrading and up staging.
  
  
  METHODS
  SABOR is a Clinical and Epidemiologic Center of the EDRN (Early Detection Research Network), NCI (National Cancer Institute), with 3,828 men enrolled at the time of review. Of these men 320 were diagnosed with prostate cancer, of whom 281 had sufficient data for review. These 281 cases were reviewed to determine suitability for active surveillance using 2 sets of criteria. Criteria 1 were prostate specific antigen density less than 15%, 2 or fewer cores involved with cancer, Gleason score 6 or less and cancer involving 50% or less of biopsy volume. Criteria 2 were 4 or fewer cores with Gleason 3 + 3 cancer and only 1 core of Gleason 3 + 4 cancer with up to 15% of core involved with Gleason 3 + 4 disease. For those undergoing radical prostatectomy, we examined rates of up staging and upgrading.
  
  
  RESULTS
  Of the 281 patients, 187 (67%) qualified for active surveillance under criteria 1 and/or 2. Treatment data were available on 178 patients, and 74 underwent radical prostatectomy. Using the initial biopsy, 14 men (33.1%) who met criteria 1 and 9 (25%) who met criteria 2 were upgraded and/or up staged on final pathological review. By comparison, 38% of those who did not qualify for active surveillance were upgraded and/or up staged.
  
  
  CONCLUSIONS
  In a population based cohort, two-thirds of men diagnosed with prostate cancer qualify for active surveillance. Less restricted criteria for surveillance may be appropriate based on similar rates of upgrading/up staging at radical prostatectomy.
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Stephen
authors: S
authors: Overholser
authors: School of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Matthew
authors: M
authors: Nielsen
authors: Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado.
authors: Kathleen
authors: K
authors: Torkko
authors: School of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Daniel
authors: D
authors: Cwilka
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Brandi
authors: B
authors: Weaver
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Xiaoyu
authors: X
authors: Shi
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Robin J
authors: RJ
authors: Leach
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Javier
authors: J
authors: Hernandez
authors: Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Tim
authors: T
authors: Huang
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Ian M
authors: IM
authors: Thompson
authors: Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address: thompsonim@uthscsa.edu.
authors: Ian M
authors: IM
authors: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D017430:Prostate-Specific Antigen
keywords: biopsy; prostate-specific antigen; prostatectomy; prostatic neoplasms; watchful waiting