摘要
We aimed to analyze the value of each criterion for clinically insignificant prostate cancer （PCa） in the selection of men for active surveillance （AS） of low-risk PCa. We identified 532 men who were treated with radical prostatectomy from 2006 to 2013 who met 4 or all 5 of the criteria for clinically insignificant PCa （clinical stage 〈 T1, prostate specific antigen [PSA] density 0.15, biopsy Gleason score 〈 6, number of positive biopsy cores 〈 2, and no core with 〉 50% involvement） and analyzed their pathologic and biochemical outcomes. Patients who met all 5 criteria for clinically insignificant PCa were designated as group A （n -- 172）, and those who met 4 of 5 criteria were designated as group B （n = 360）. The association of each criterion with adverse pathologic features was assessed via logistic regression analyses. Comparison of group A and B and also logistic regression analyses showed that PSA density 0.15 ng ml-1 and high （〉7） biopsy Gleason score were associated with adverse pathologic features. Higher （〉 Tlc） clinical stage was not associated with any adverse pathologic features. Although 〈 3 positive cores were not associated with any adverse pathology, 〉4 positive cores were associated with higher risk of extracapsular extension. Among potential candidates for AS, PSA density ~ 0.15 ng ml-~ and biopsy Gleason score ~ 6 pose significantly higher risks of harboring more aggressive disease. The eligibility criteria for AS may be expanded to include men with clinical stage T2 tumor and 3 positive cores.
We aimed to analyze the value of each criterion for clinically insignificant prostate cancer （PCa） in the selection of men for active surveillance （AS） of low-risk PCa. We identified 532 men who were treated with radical prostatectomy from 2006 to 2013 who met 4 or all 5 of the criteria for clinically insignificant PCa （clinical stage 〈 T1, prostate specific antigen [PSA] density 0.15, biopsy Gleason score 〈 6, number of positive biopsy cores 〈 2, and no core with 〉 50% involvement） and analyzed their pathologic and biochemical outcomes. Patients who met all 5 criteria for clinically insignificant PCa were designated as group A （n -- 172）, and those who met 4 of 5 criteria were designated as group B （n = 360）. The association of each criterion with adverse pathologic features was assessed via logistic regression analyses. Comparison of group A and B and also logistic regression analyses showed that PSA density 0.15 ng ml-1 and high （〉7） biopsy Gleason score were associated with adverse pathologic features. Higher （〉 Tlc） clinical stage was not associated with any adverse pathologic features. Although 〈 3 positive cores were not associated with any adverse pathology, 〉4 positive cores were associated with higher risk of extracapsular extension. Among potential candidates for AS, PSA density ~ 0.15 ng ml-~ and biopsy Gleason score ~ 6 pose significantly higher risks of harboring more aggressive disease. The eligibility criteria for AS may be expanded to include men with clinical stage T2 tumor and 3 positive cores.
