title: Pathological Outcome following Radical Prostatectomy in Men with Prostate Specific Antigen Greater than 10 ng/ml and Histologically Favorable Risk Prostate Cancer.
abstract: OBJECTIVE
  Active surveillance is now the treatment of choice in men with low risk prostate cancer. Although there is no consensus on which patients are eligible for active surveillance, prostate specific antigen above 10 ng/ml is generally excluded. In an attempt to determine the validity of using a prostate specific antigen cutoff of 10 ng/ml to counsel men considering active surveillance we analyzed a multi-institution database to determine the pathological outcome in men with prostate specific antigen greater than 10 ng/ml but histologically favorable risk prostate cancer.
  
  
  METHODS
  We queried a prospectively maintained database of men with histologically favorable risk prostate cancer who underwent radical prostatectomy between 2003 and 2015. The cohort was categorized into 3 groups based on prostate specific antigen level, including low-less than 10 ng/ml, intermediate-10 or greater to less than 20 and high-20 or greater. Associations of prostate specific antigen group with adverse pathological and oncologic outcomes were analyzed.
  
  
  RESULTS
  Of 2,125 patients 1,327 were categorized with histologically favorable risk disease. However on multivariate analyses the rates of up staging and upgrading were similar between the intermediate and low prostate specific antigen groups. In contrast compared to the intermediate prostate specific antigen group the high group had higher incidences of up staging (p = 0.02) and upgrading to 4 + 3 or greater disease (p = 0.046). Biochemical recurrence-free survival rates revealed no pairwise intergroup differences except between the low and high groups.
  
  
  CONCLUSIONS
  Patients with preoperatively elevated prostate specific antigen between 10 and less than 20 ng/ml who otherwise had histologically favorable risk prostate cancer were not at higher risk for adverse pathological outcomes than men with prostate specific antigen less than 10 ng/ml.
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick.
authors.forename: Jiwoong
authors.initials: J
authors.lastname: Yu
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick; Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick; Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey.
authors.forename: Sinae
authors.initials: S
authors.lastname: Kim
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick.
authors.forename: Christopher Sejong
authors.initials: CS
authors.lastname: Han
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Farber
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick.
authors.forename: Jongmyung
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Seok Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
authors.forename: Wun-Jae
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: seongsoo.jeon@samsung.com.
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick. Electronic address: kimiy@cinj.rutgers.edu.
authors.forename: Isaac Yi
authors.initials: IY
authors.lastname: Kim
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009515:New Jersey / Q000453:epidemiology; D011379:Prognosis; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: outcome assessment (health care); prostate-specific antigen; prostatic neoplasms; risk; watchful waiting