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Analysis of expanded criteria to select candidates for active surveillance of low-risk prostate cancer

Asian journal of Andrology 2015年第2期17卷 248-252,I0008,I0009页

作者： jung ki jo hart sol lee young ik lee sang eun lee sung kyu hong Department of Urology Seoul National University Bundang Hospital Seongnam Korea.

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.

关键词： prediction prostate prostatectomy prostatic neoplasms risk

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