PURPOSE: Low-risk prostate cancer patients clinically eligible for active surveillance can also be managed surgically. We evaluated the pathologic outcomes for this cohort that was treated by radical prostatectomy and devised nomograms to predict patients at risk of upgrading and/or upstaging. MATERIALS AND METHODS: Seven hundred and fifty patients treated by radical prostatectomy from Jan 2005 to the present fulfilled conventional active surveillance criteria and formed the study cohort. Preoperative data on standard clinicopathologic parameters were available. The radical prostatectomy specimens were graded and staged, and any upgrading to Gleason sum >6 or upstaging to ≥pT3 ('worsening prognosis') were noted. Multivariable logistic regression models were used to develop predictive nomograms. RESULTS: Of the 750 patients, 303 (40.4%) patients were either upgraded or upstaged. Multivariable analysis found that preoperative PSA, number of positive cores, and prostate volume were significantly predictive of worsening prognosis and formed the nomogram criteria. CONCLUSIONS: Of patients deemed eligible for active surveillance based on conventional criteria, 40.4% have worse prognostic factors after radical prostatectomy. Current active surveillance criteria may be too relaxed, and the use of nomograms which we have devised, may aid in counseling primary prostate cancer patients considering active surveillance as their therapy of choice.
PURPOSE: Low-risk prostate cancerpatients clinically eligible for active surveillance can also be managed surgically. We evaluated the pathologic outcomes for this cohort that was treated by radical prostatectomy and devised nomograms to predict patients at risk of upgrading and/or upstaging. MATERIALS AND METHODS: Seven hundred and fifty patients treated by radical prostatectomy from Jan 2005 to the present fulfilled conventional active surveillance criteria and formed the study cohort. Preoperative data on standard clinicopathologic parameters were available. The radical prostatectomy specimens were graded and staged, and any upgrading to Gleason sum >6 or upstaging to ≥pT3 ('worsening prognosis') were noted. Multivariable logistic regression models were used to develop predictive nomograms. RESULTS: Of the 750 patients, 303 (40.4%) patients were either upgraded or upstaged. Multivariable analysis found that preoperative PSA, number of positive cores, and prostate volume were significantly predictive of worsening prognosis and formed the nomogram criteria. CONCLUSIONS: Of patients deemed eligible for active surveillance based on conventional criteria, 40.4% have worse prognostic factors after radical prostatectomy. Current active surveillance criteria may be too relaxed, and the use of nomograms which we have devised, may aid in counseling primary prostate cancerpatients considering active surveillance as their therapy of choice.
Authors: W C Allsbrook; K A Mangold; M H Johnson; R B Lane; C G Lane; M B Amin; D G Bostwick; P A Humphrey; E C Jones; V E Reuter; W Sakr; I A Sesterhenn; P Troncoso; T M Wheeler; J I Epstein Journal: Hum Pathol Date: 2001-01 Impact factor: 3.466
Authors: Jehonathan H Pinthus; Maciej Witkos; N E Fleshner; Joan Sweet; Andrew Evans; M A Jewett; Murray Krahn; Shabir Alibhai; John Trachtenberg Journal: J Urol Date: 2006-09 Impact factor: 7.450
Authors: Stephen J Freedland; William B Isaacs; Elizabeth A Platz; Martha K Terris; William J Aronson; Christopher L Amling; Joseph C Presti; Christopher J Kane Journal: J Clin Oncol Date: 2005-10-20 Impact factor: 44.544
Authors: Manish I Patel; Dino T DeConcini; Ernesto Lopez-Corona; Makato Ohori; Thomas Wheeler; Peter T Scardino Journal: J Urol Date: 2004-04 Impact factor: 7.450