Kei Mizuno1, Takahiro Inoue2, Hidefumi Kinoshita3, Toshifumi Yano4, Hiroaki Kawanishi5, Hideki Kanda6, Naoki Terada2, Takashi Kobayashi2, Tomomi Kamba2, Yoshiki Mikami7, Taizo Shiraishi8, Yoshiko Uemura9, Yukihiro Imai10, Gen Honjo11, Tomoyuki Shirase12, Kazuhiro Okumura5, Mutsushi Kawakita4, Keiji Ogura1, Yoshiki Sugimura6, Tadashi Matsuda3, Osamu Ogawa13. 1. Department of Urology, Japanese Red Cross Otsu Hospital, Otsu. 2. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto. 3. Department of Urology and Andrology, Kansai Medical University, Hirakata. 4. Department of Urology, Kobe City Medical Center General Hospital, Kobe. 5. Department of Urology, Tenri Hospital, Tenri. 6. Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu. 7. Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto. 8. Department of Oncologic Pathology, Mie University Graduate School of Medicine, Tsu. 9. Depatment of Clinical Pathology, Kansai Medical University, Hirakata. 10. Department of Pathology, Kobe City Medical Center General Hospital, Kobe. 11. Department of Pathology, Tenri Hospital, Tenri. 12. Department of Pathology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 13. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto ogawao@kuhp.kyoto-u.ac.jp.
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.
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: Kerri Beckmann; Michael O'Callaghan; Andrew Vincent; Penelope Cohen; Martin Borg; David Roder; Sue Evans; Jeremy Millar; Kim Moretti Journal: Asian J Urol Date: 2019-03-07