Testing the most stringent criteria for selection of candidates for active surveillance in patients with low-risk prostate cancer

Nazareno Suardi, Alberto Briganti, Andrea Gallina, Andrea Salonia, Pierre I. Karakiewicz, Umberto Capitanio, Massimo Freschi, Andrea Cestari, Giorgio Guazzoni, Patrizio Rigatti, Francesco Montorsi

Research output: Contribution to journalArticle

Abstract

Study Type - Prognosis (case series) Level of Evidence 4 Objective To test the ability of two of the most stringent criteria used to identify patients with low-risk prostate cancer suitable for active surveillance (AS) to correctly exclude patients with unfavourable prostate cancer characteristics. Patients and Methods The study included 874 consecutive patients treated with radical prostatectomy (RP). We selected patients who could have been selected for AS according to the van den Bergh et al. and the Carter et al. criteria. We analysed the rates of advanced disease in these patients, defined as presence of either extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI) and Gleason sum of 8-10 or 7-10. Results Of 874 patients, 85 (9.7%) and 61 (6.9%) patients, respectively, qualified for AS according to the tested criteria. Within the van den Bergh et al. candidates, 5.9, 1.2, 1.2 and 1.2% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10 at pathology. Within the Carter et al. candidates, 3.3, 0, 3.3 and 0% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10. The cumulative rate of unfavourable characteristics was 7.1 and 3.3%. The rate increased to 28.2 and 27.9%, respectively, when Gleason sum 7 was considered as an unfavourable prostate cancer. Conclusions The use of the strictest criteria for AS inclusion identified 7-10% of the men in our cohort of men undergoing RP, as men that would have been eligible for AS. Among this small proportion, between 3.3 and 7.1% of patients harboured unfavourable prostate cancer characteristics. The clinical implications of these misclassification rates remain to be determined.

Original languageEnglish
Pages (from-to)1548-1552
Number of pages5
JournalBJU International
Volume105
Issue number11
DOIs
Publication statusPublished - Jun 2010

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Patient Selection
Prostatic Neoplasms
Seminal Vesicles
Lymph Nodes
Prostatectomy
Pathology

Keywords

  • Active surveillance
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

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Testing the most stringent criteria for selection of candidates for active surveillance in patients with low-risk prostate cancer. / Suardi, Nazareno; Briganti, Alberto; Gallina, Andrea; Salonia, Andrea; Karakiewicz, Pierre I.; Capitanio, Umberto; Freschi, Massimo; Cestari, Andrea; Guazzoni, Giorgio; Rigatti, Patrizio; Montorsi, Francesco.

In: BJU International, Vol. 105, No. 11, 06.2010, p. 1548-1552.

Research output: Contribution to journalArticle

Suardi, Nazareno ; Briganti, Alberto ; Gallina, Andrea ; Salonia, Andrea ; Karakiewicz, Pierre I. ; Capitanio, Umberto ; Freschi, Massimo ; Cestari, Andrea ; Guazzoni, Giorgio ; Rigatti, Patrizio ; Montorsi, Francesco. / Testing the most stringent criteria for selection of candidates for active surveillance in patients with low-risk prostate cancer. In: BJU International. 2010 ; Vol. 105, No. 11. pp. 1548-1552.
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abstract = "Study Type - Prognosis (case series) Level of Evidence 4 Objective To test the ability of two of the most stringent criteria used to identify patients with low-risk prostate cancer suitable for active surveillance (AS) to correctly exclude patients with unfavourable prostate cancer characteristics. Patients and Methods The study included 874 consecutive patients treated with radical prostatectomy (RP). We selected patients who could have been selected for AS according to the van den Bergh et al. and the Carter et al. criteria. We analysed the rates of advanced disease in these patients, defined as presence of either extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI) and Gleason sum of 8-10 or 7-10. Results Of 874 patients, 85 (9.7{\%}) and 61 (6.9{\%}) patients, respectively, qualified for AS according to the tested criteria. Within the van den Bergh et al. candidates, 5.9, 1.2, 1.2 and 1.2{\%} of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10 at pathology. Within the Carter et al. candidates, 3.3, 0, 3.3 and 0{\%} of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10. The cumulative rate of unfavourable characteristics was 7.1 and 3.3{\%}. The rate increased to 28.2 and 27.9{\%}, respectively, when Gleason sum 7 was considered as an unfavourable prostate cancer. Conclusions The use of the strictest criteria for AS inclusion identified 7-10{\%} of the men in our cohort of men undergoing RP, as men that would have been eligible for AS. Among this small proportion, between 3.3 and 7.1{\%} of patients harboured unfavourable prostate cancer characteristics. The clinical implications of these misclassification rates remain to be determined.",
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AU - Salonia, Andrea

AU - Karakiewicz, Pierre I.

AU - Capitanio, Umberto

AU - Freschi, Massimo

AU - Cestari, Andrea

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N2 - Study Type - Prognosis (case series) Level of Evidence 4 Objective To test the ability of two of the most stringent criteria used to identify patients with low-risk prostate cancer suitable for active surveillance (AS) to correctly exclude patients with unfavourable prostate cancer characteristics. Patients and Methods The study included 874 consecutive patients treated with radical prostatectomy (RP). We selected patients who could have been selected for AS according to the van den Bergh et al. and the Carter et al. criteria. We analysed the rates of advanced disease in these patients, defined as presence of either extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI) and Gleason sum of 8-10 or 7-10. Results Of 874 patients, 85 (9.7%) and 61 (6.9%) patients, respectively, qualified for AS according to the tested criteria. Within the van den Bergh et al. candidates, 5.9, 1.2, 1.2 and 1.2% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10 at pathology. Within the Carter et al. candidates, 3.3, 0, 3.3 and 0% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10. The cumulative rate of unfavourable characteristics was 7.1 and 3.3%. The rate increased to 28.2 and 27.9%, respectively, when Gleason sum 7 was considered as an unfavourable prostate cancer. Conclusions The use of the strictest criteria for AS inclusion identified 7-10% of the men in our cohort of men undergoing RP, as men that would have been eligible for AS. Among this small proportion, between 3.3 and 7.1% of patients harboured unfavourable prostate cancer characteristics. The clinical implications of these misclassification rates remain to be determined.

AB - Study Type - Prognosis (case series) Level of Evidence 4 Objective To test the ability of two of the most stringent criteria used to identify patients with low-risk prostate cancer suitable for active surveillance (AS) to correctly exclude patients with unfavourable prostate cancer characteristics. Patients and Methods The study included 874 consecutive patients treated with radical prostatectomy (RP). We selected patients who could have been selected for AS according to the van den Bergh et al. and the Carter et al. criteria. We analysed the rates of advanced disease in these patients, defined as presence of either extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI) and Gleason sum of 8-10 or 7-10. Results Of 874 patients, 85 (9.7%) and 61 (6.9%) patients, respectively, qualified for AS according to the tested criteria. Within the van den Bergh et al. candidates, 5.9, 1.2, 1.2 and 1.2% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10 at pathology. Within the Carter et al. candidates, 3.3, 0, 3.3 and 0% of patients, respectively, showed ECE, SVI, LNI and high-grade Gleason sum 8-10. The cumulative rate of unfavourable characteristics was 7.1 and 3.3%. The rate increased to 28.2 and 27.9%, respectively, when Gleason sum 7 was considered as an unfavourable prostate cancer. Conclusions The use of the strictest criteria for AS inclusion identified 7-10% of the men in our cohort of men undergoing RP, as men that would have been eligible for AS. Among this small proportion, between 3.3 and 7.1% of patients harboured unfavourable prostate cancer characteristics. The clinical implications of these misclassification rates remain to be determined.

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