Cancer Res Treat.  2018 Jan;50(1):265-274. 10.4143/crt.2016.477.

Selection Criteria for Active Surveillance of Patients with Prostate Cancer in Korea: A Multicenter Analysis of Pathology after Radical Prostatectomy

• Jeong CW
• Hong SK
• Byun SS
• Jeon SS
• Seo SI
• Lee HM
• Ahn H
• Kwon DD
• Ha HK
• Kwon TG
• Chung JS
• Kwak C
• Kim HJ

• KMID: 2403495
• DOI: http://doi.org/10.4143/crt.2016.477

Abstract

PURPOSE
Korean patients with prostate cancer (PC) typically present with a more aggressive disease than patients in Western populations. Consequently, it is unclear if the current criteria for active surveillance (AS) can safely be applied to Korean patients. Therefore, this study was conducted to define appropriate selection criteria for AS for patients with PC in Korea.
MATERIALS AND METHODS
We conducted a multicenter retrospective study of 2,126 patients with low risk PC who actually underwent radical prostatectomy. The primary outcome was an unfavorable disease, which was defined by non-organ confined disease or an upgrading of the Gleason score to ≥ 7 (4+3). Predictive variables of an unfavorable outcome were identified by multivariate analysis using randomly selected training samples (n=1,623, 76.3%). We compared our selected criteria to various Western criteria for the primary outcome and validated our criteria using the remaining validation sample (n=503, 23.7%).
RESULTS
A non-organ confined disease rate of 14.9% was identified, with an increase in Gleason score ≥ 7 (4+3) of 8.7% and a final unfavorable disease status of 20.8%. The following criteria were selected: Gleason score ≤ 6, clinical stage T1-T2a, prostate-specific antigen (PSA) ≤ 10 ng/mL, PSA density < 0.15 ng/mL/mL, number of positive cores ≤ 2, and maximum cancer involvement in any one core ≤ 20%. These criteria provided the lowest unfavorable disease rate (11.7%) when compared to Western criteria (13.3%-20.7%), and their validity was confirmed using the validation sample (5.9%).
CONCLUSION
We developed AS criteria which are appropriate for Korean patients with PC. Prospective studies using these criteria are now warranted.

Keyword

Prostatic neoplasms; Observation; Prostatectomy; Pathology

MeSH Terms

Humans
Korea*
Multivariate Analysis
Neoplasm Grading
Pathology*
Patient Selection*
Prospective Studies
Prostate*
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms*
Retrospective Studies
Prostate-Specific Antigen

Figure

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  Fig. 1. Biochemical recurrence-free survival curve.

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  Fig. 2. Curve fitting analysis for the odds ratio for an unfavorable disease outcome (A-C) or the hazard ratio for biochemical recurrence-free survival (D-F). PSAD, prostate specific antigen density; PPC, percent positive cores; MPC, maximum cancer percentage in any core.

Reference

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