title: Pathological upgrading in prostate cancer patients eligible for active surveillance: Does prostate-specific antigen density matter?
abstract: OBJECTIVE
  To evaluate prospectively the role of prostate-specific antigen (PSA) density in predicting Gleason score upgrading in prostate cancer patients eligible for active surveillance (T1/T2, biopsy Gleason score≤6, PSA≤10 ng/mL, and ≤2 positive biopsy cores).
  
  
  METHODS
  Between January 2010 and November 2013, among patients who underwent greater than 10-core transrectal ultrasound-guided biopsy, 60 patients eligible for active surveillance underwent radical prostatectomy. By use of the modified Gleason criteria, the tumor grade of the surgical specimens was examined and compared with the biopsy results.
  
  
  RESULTS
  Tumor upgrading occurred in 24 patients (40.0%). Extracapsular disease and positive surgical margins were found in 6 patients (10.0%) and 8 patients (17.30%), respectively. A statistically significant correlation between PSA density and postoperative upgrading was found (p=0.030); this was in contrast with the other studied parameters, which failed to reach significance, including PSA, prostate volume, number of biopsy cores, and number of positive cores. Tumor upgrading was also highly associated with extracapsular cancer extension (p=0.000). The estimated optimal cutoff value of PSA density was 0.13 ng/mL(2), obtained by receiver operating characteristic analysis (area under the curve=0.66; p=0.020; 95% confidence interval, 0.53-0.78).
  
  
  CONCLUSIONS
  PSA density is a strong predictor of Gleason score upgrading after radical prostatectomy in patients eligible for active surveillance. Because tumor upgrading increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients eligible for active surveillance.
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Jin
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Seok-Hyun
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Duk-Yoon
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Hoon-Gyu
authors.initials: HG
authors.lastname: Oh
authors.affiliation: Department of Urology, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Chun-Il
authors.initials: CI
authors.lastname: Kim
authors.affiliation: Department of Urology, Yeungnam University School of Medicine, Daegu, Korea.
authors.forename: Gi-Hak
authors.initials: GH
authors.lastname: Moon
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Tae-Gyun
authors.initials: TG
authors.lastname: Kwon
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Jae-Shin
authors.initials: JS
authors.lastname: Park
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Neoplasm grading; Prostate specific antigen; Prostatectomy