title: Evaluation of predictors of unfavorable pathological features in men eligible for active surveillance using radical prostatectomy specimens: a multi-institutional study.
abstract: OBJECTIVE
  Active surveillance has emerged as an alternative to immediate treatment in men with favorable-risk prostate cancer; however, consensus about defining the appropriate candidates is still lacking. To examine the factors predicting unfavorable pathology among active surveillance candidates, we assessed low-risk radical prostatectomy specimens.
  
  
  METHODS
  This retrospective study included 1753 men who had undergone radical prostatectomy at six independent institutions in Japan from 2005 to 2011. Patients who met the active surveillance criteria were categorized depending on the pathological features of the radical prostatectomy specimens. 'Reclassification' was defined as upstaging (≥pT3) or upgrading (radical prostatectomy Gleason score ≥7), and 'adverse pathology' was defined as pathological stage ≥pT3 or radical prostatectomy Gleason score ≥4 + 3. Multivariate analysis was used to analyze the preoperative factors for reclassification and adverse pathology. The rates of reclassification and adverse pathology were evaluated by classifying patients according to biopsy core numbers.
  
  
  RESULTS
  The active surveillance criteria were met by 284 cases. Reclassification was identified in 154 (54.2%) cases, while adverse pathology in 60 (21.1%) cases. Prostate-specific antigen density and percentage of positive cores were independently associated with reclassification and adverse pathology. The rates of reclassification and adverse pathology were significantly higher among patients with <10 biopsy cores than among others. Thus, focusing on 149 patients with ≥10 biopsy cores, prostate-specific antigen density was the only independent predictor of unfavorable pathological features. The receiver operating characteristic curve analysis determines an optimal cut-off value of prostate-specific antigen density as 0.15 ng/ml2.
  
  
  CONCLUSIONS
  Prostate-specific antigen density is the most important predictor of unfavorable pathological features in active surveillance candidates.
authors.affiliation: Department of Urology, Japanese Red Cross Otsu Hospital, Otsu.
authors.forename: Kei
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology, Kobe City Medical Center General Hospital, Kobe.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Yano
authors.affiliation: Department of Urology, Tenri Hospital, Tenri.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawanishi
authors.affiliation: Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kanda
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto.
authors.forename: Naoki
authors.initials: N
authors.lastname: Terada
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kamba
authors.affiliation: Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu.
authors.forename: Taizo
authors.initials: T
authors.lastname: Shiraishi
authors.affiliation: Depatment of Clinical Pathology, Kansai Medical University, Hirakata.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Pathology, Kobe City Medical Center General Hospital, Kobe.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Department of Pathology, Tenri Hospital, Tenri.
authors.forename: Gen
authors.initials: G
authors.lastname: Honjo
authors.affiliation: Department of Pathology, Japanese Red Cross Otsu Hospital, Otsu, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Shirase
authors.affiliation: Department of Urology, Tenri Hospital, Tenri.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Department of Urology, Kobe City Medical Center General Hospital, Kobe.
authors.forename: Mutsushi
authors.initials: M
authors.lastname: Kawakita
authors.affiliation: Department of Urology, Japanese Red Cross Otsu Hospital, Otsu.
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.affiliation: Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sugimura
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto ogawao@kuhp.kyoto-u.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D019540:Area Under Curve; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
keywords: active surveillance; prostate cancer; prostate-specific antigen density