Currently used criteria for active surveillance in men with low-risk prostate cancer

An analysis of pathologic features

Authors

  • Nazareno Suardi MD,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
    2. Department of Urology, Vita-Salute San Raffaele, Milan, Italy
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    • The first and second authors contributed equally to this article.

  • Umberto Capitanio MD,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
    2. Department of Urology, Vita-Salute San Raffaele, Milan, Italy
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    • The first and second authors contributed equally to this article.

  • Felix K. H. Chun MD,

    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
    2. Department of Urology, University of Hamburg, Hamburg, Germany
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  • Markus Graefen MD,

    1. Department of Urology, University of Hamburg, Hamburg, Germany
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  • Paul Perrotte MD,

    1. Department of Urology, University of Montreal, Montreal, Canada
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  • Thorsten Schlomm MD,

    1. Department of Urology, University of Hamburg, Hamburg, Germany
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  • Alexander Haese MD,

    1. Department of Urology, University of Hamburg, Hamburg, Germany
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  • Hartwig Huland MD,

    1. Department of Urology, University of Hamburg, Hamburg, Germany
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  • Andreas Erbersdobler MD,

    1. Department of Pathology, University of Hamburg, Hamburg, Germany
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  • Francesco Montorsi MD,

    1. Department of Urology, Vita-Salute San Raffaele, Milan, Italy
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  • Pierre I. Karakiewicz MD

    Corresponding author
    1. Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
    2. Department of Urology, University of Montreal, Montreal, Canada
    • Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montréal, Québec, Canada, H2X 3J4
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    • Fax: (514) 412-7363;

    • Pierre I. Karakiewicz is supported in part by the University of Montreal Health Center Urology Associated, Fonds de la Recherche en Santè du Quebec, the University of Montreal Department of Surgery, and the University of Montreal Health Center Foundation.


Abstract

BACKGROUND.

Active surveillance (AS) represents a treatment option for select patients with low-risk, organ-confined prostate cancer (PCa). In this report, the authors addressed the rates of misclassification associated with the use of 5 different clinical criteria for AS. Misclassification was defined as the presence of either nonorgan-confined disease or high-grade PCa.

METHODS.

Between 1992 and 2007, 4885 patients underwent radical prostatectomy (RP) at 1 of 2 European academic centers, and the patients were identified who fulfilled the criteria for AS according to 5 different investigational groups (Hardie et al, Roemeling et al, Choo et al, Klotz, and D'Amico and Coleman). Statistics targeted the rates of misclassification for each of the 5 definitions.

RESULTS.

Four thousand three hundred eight patients, 4047 patients, 3993 patients, 2455 patients, and 2345 patients fulfilled the AS criteria of Hardie et al, Roemeling et al, Choo et al, Klotz, and D'Amico and Coleman, respectively. Extracapsular extension was reported in 13.5% to 26% of patients, and seminal vesicle invasion was reported in 2.9% to 8.2% of patients. When PCa with Gleason scores from 8 to 10 at RP was considered high grade, the misclassification rates were 27%, 25%, 25%, 15%, and 14% for the 5 studies, respectively. Conversely, when PCa with Gleason scores from 7 to 10 was considered high grade, the misclassification rates increased to 56%, 55%, 45%, 42%, and 39%, respectively.

CONCLUSIONS.

The currently available AS criteria are limited by a high rate of misclassification. The use of more selective AS criteria may reduce the rate of misclassification but also may reduce significantly the percentage of patients who may be considered for AS. Cancer 2008. © 2008 American Cancer Society.

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