Are active surveillance criteria sufficient for predicting advanced stage prostate cancer patients? ¿son los criterios de vigilancia activa suficientes para predecir el cáncer de próstata de estadio avanzado?


Ongun S., ÇELİK S. G. , Gül-Niflioglu G., ASLAN G., TUNA E. B. , Mungan U., ...More

Actas Urologicas Espanolas, vol.38, no.8, pp.499-505, 2014 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 38 Issue: 8
  • Publication Date: 2014
  • Doi Number: 10.1016/j.acuro.2013.11.005
  • Title of Journal : Actas Urologicas Espanolas
  • Page Numbers: pp.499-505
  • Keywords: Neoplasm staging, Prostatectomy, Prostatic neoplasms, Tumor burden, ISUP CONSENSUS CONFERENCE, RADICAL PROSTATECTOMY, TUMOR VOLUME, INTERNATIONAL-SOCIETY, BIOPSY, MEN, MANAGEMENT, SCORE

Abstract

© 2013 AEU. Published by Elsevier Espaa, S.L.U. All rights reserved.Objectives: To examine the treatment outcomes of the prostate cancer (PCa) patients treatedby radical prostatectomy (RP) who could be good candidates for active surveillance (AS) andtest the confidence and reliability of the AS criterias for predicting advanced stage disease (RPGleason score ≥ 7 or Pathological stage T3).Methods: Between 2005 and 2012 the records of the 401 patients who underwent RP with adiagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. Theinclusion criteria were as follows; clinical stage T2a or less, PSA < 10 ng/ml, 2 or fewer coresinvolved with cancer, no single core with 50% or greater maximum involvement of cancer, andno Gleason grade greater than 3 in the specimen.Results: Univariate analyzes revealed that patients with advanced stage disease have higherprostate specific antigen density (PSAD), higher maximum percent (max%) in positive cores andhigher RP tumor volumes. In multivariate analyzes PSAD, max% in positive cores and RP tumorvolumes were statistically significant determinants for advanced stage disease. ROC analyzesrevealed that the RP tumor volume is a good test on advanced stage disease.Conclusions: Decreasing the cutoff values for PSAD and max% in positive cores should be con-sidered for AS inclusion criteria. If we could calculate the tumor volume before RP, we canminimize the treatment failures (over or undertreatment) of PCa. Perhaps new biopsy protocols,tissue biomarkers, and molecular imaging technology may refine AS criteria.