PURPOSE: A paucity of data exists on the insignificant disease potentially suitable for active surveillance (AS) among men with intermediate-risk prostate cancer (PCa). We tried to identify pathologically insignificant disease and its preoperative predictors in men who underwent radical prostatectomy (RP) for intermediate-risk PCa. METHODS: We analyzed data of 1,630 men who underwent RP for intermediate-risk disease. Total tumor volume (TTV) data were available in 332 men. We examined factors associated with classically defined pathologically insignificant cancer (organ-confined disease with TTV ≤0.5 ml with no Gleason pattern 4 or 5) and pathologically favorable cancer (organ-confined disease with no Gleason pattern 4 or 5) potentially suitable for AS. Decision curve analysis was used to assess clinical utility of a multivariable model including preoperative variables for predicting pathologically unfavorable cancer. RESULTS: In the entire cohort, 221 of 1,630 (13.6 %) total patients had pathologically favorable cancer. Among 332 patients with TTV data available, 26 (7.8 %) had classically defined pathologically insignificant cancer. Between threshold probabilities of 20 and 40 %, decision curve analysis demonstrated that using multivariable model to identify AS candidates would not provide any benefit over simply treating all men who have intermediate-risk disease with RP. CONCLUSION: Although a minority of patients with intermediate-risk disease may harbor pathologically favorable or insignificant cancer, currently available conventional tools are not sufficiently able to identify those patients.
PURPOSE: A paucity of data exists on the insignificant disease potentially suitable for active surveillance (AS) among men with intermediate-risk prostate cancer (PCa). We tried to identify pathologically insignificant disease and its preoperative predictors in men who underwent radical prostatectomy (RP) for intermediate-risk PCa. METHODS: We analyzed data of 1,630 men who underwent RP for intermediate-risk disease. Total tumor volume (TTV) data were available in 332 men. We examined factors associated with classically defined pathologically insignificant cancer (organ-confined disease with TTV ≤0.5 ml with no Gleason pattern 4 or 5) and pathologically favorable cancer (organ-confined disease with no Gleason pattern 4 or 5) potentially suitable for AS. Decision curve analysis was used to assess clinical utility of a multivariable model including preoperative variables for predicting pathologically unfavorable cancer. RESULTS: In the entire cohort, 221 of 1,630 (13.6 %) total patients had pathologically favorable cancer. Among 332 patients with TTV data available, 26 (7.8 %) had classically defined pathologically insignificant cancer. Between threshold probabilities of 20 and 40 %, decision curve analysis demonstrated that using multivariable model to identify AS candidates would not provide any benefit over simply treating all men who have intermediate-risk disease with RP. CONCLUSION: Although a minority of patients with intermediate-risk disease may harbor pathologically favorable or insignificant cancer, currently available conventional tools are not sufficiently able to identify those patients.
Authors: Tineke Wolters; Monique J Roobol; Pim J van Leeuwen; Roderick C N van den Bergh; Robert F Hoedemaeker; Geert J L H van Leenders; Fritz H Schröder; Theodorus H van der Kwast Journal: J Urol Date: 2010-11-12 Impact factor: 7.450
Authors: Guillaume Ploussard; Jonathan I Epstein; Rodolfo Montironi; Peter R Carroll; Manfred Wirth; Marc-Oliver Grimm; Anders S Bjartell; Francesco Montorsi; Stephen J Freedland; Andreas Erbersdobler; Theodorus H van der Kwast Journal: Eur Urol Date: 2011-05-17 Impact factor: 20.096
Authors: Kazuma Udo; Angel M Cronin; Lauren J Carlino; Caroline J Savage; Alexandra C Maschino; Hikmat A Al-Ahmadie; Anuradha Gopalan; Satish K Tickoo; Peter T Scardino; James A Eastham; Victor E Reuter; Samson W Fine Journal: J Urol Date: 2012-10-09 Impact factor: 7.450
Authors: Michael C Lee; Fei Dong; Andrew J Stephenson; J Stephen Jones; Cristina Magi-Galluzzi; Eric A Klein Journal: Eur Urol Date: 2009-10-23 Impact factor: 20.096
Authors: Meelan Bul; Roderick C N van den Bergh; Xiaoye Zhu; Antti Rannikko; Hanna Vasarainen; Chris H Bangma; Fritz H Schröder; Monique J Roobol Journal: BJU Int Date: 2012-08-29 Impact factor: 5.588
Authors: Constantin Georgescu; Joshua M Corbin; Sandra Thibivilliers; Zachary D Webb; Yan D Zhao; Jan Koster; Kar-Ming Fung; Adam S Asch; Jonathan D Wren; Maria J Ruiz-Echevarría Journal: BMC Cancer Date: 2019-05-06 Impact factor: 4.430
Authors: Dianne van Strijp; Christiane de Witz; Pieter C Vos; Eveline den Biezen-Timmermans; Anne van Brussel; Janneke Wrobel; George S Baillie; Pierre Tennstedt; Thorsten Schlomm; Birthe Heitkötter; Sebastian Huss; Martin Bögemann; Miles D Houslay; Chris Bangma; Axel Semjonow; Ralf Hoffmann Journal: Prostate Cancer Date: 2018-07-26