Potential Consequences of Low Biopsy Core Number in Selection of Patients With Prostate Cancer for Current Active Surveillance Protocols

Objective To compare the performance of the Epstein criteria and the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria in the identification of patients eligible for active surveillance (AS) but treated with radical prostatectomy. Materials and Methods We evaluated the bas...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2013-04, Vol.81 (4), p.837-843
Main Authors: Müller, Georg, Bonkat, Gernot, Rieken, Malte, Wyler, Stephen F, Bubendorf, Lukas, Püschel, Heike, Gasser, Thomas C, Bachmann, Alexander, Rentsch, Cyrill A
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy, Large-Core Needle
Gynecology. Andrology. Obstetrics
Humans
Male
Male genital diseases
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Patient Selection
Prostate - pathology
Prostatectomy
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Prostatic Neoplasms - therapy
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
Urology
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Summary:Objective To compare the performance of the Epstein criteria and the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria in the identification of patients eligible for active surveillance (AS) but treated with radical prostatectomy. Materials and Methods We evaluated the baseline characteristics, final pathologic examination, and prostate-specific antigen follow-up (median 43 months, range 1-118) in a series of 492 consecutive patients with prostate cancer managed by radical prostatectomy without AS from 2001 to 2011 at a single institution. Using the postoperative histologic findings, multivariate analysis was used to identify the preoperative predictors of unfavorable AS selection (Gleason score >6 and/or greater than stage pT2c on the final pathologic examination). Biochemical recurrence-free survival was compared between favorably and unfavorably selected patients. Results Applying the Epstein and PRIAS criteria, 29.2% and 32.2% of the patients had Gleason score >6 or stage pT3 on final pathologic examination, respectively. After a median follow-up of 35.5 and 38 months, 4.2% and 4.3% of patients developed biochemical recurrence in the Epstein and PRIAS criteria groups, respectively. Patients with unfavorable selection had significantly worse biochemical recurrence-free survival than patients with favorable selection ( P  
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2012.10.068