World J Mens Health.  2021 Jul;39(3):550-558. 10.5534/wjmh.200037.

Predicting Insignificant Prostate Cancer: Analysis of the Pathological Outcomes of Candidates for Active Surveillance according to the Pre-International Society of Urological Pathology (Pre-ISUP) 2014 Era Versus the Post-ISUP2014 Era

• Chung MS
• Cho NH
• Kim J
• Jo Y
• Yoon BI
• Lee SH

• KMID: 2516721
• DOI: http://doi.org/10.5534/wjmh.200037

Abstract

Purpose
To analyze the difference in the prediction accuracy with an active surveillance (AS) protocol between two eras (pre-International Society of Urological Pathology [pre-ISUP]-2014 vs. post-ISUP2014).
Materials and Methods
We retrospectively analyzed 118 candidates for AS who underwent radical prostatectomy between 2009 and 2017. We divided our patients into two groups (group 1 [n=57], operation date 2009–2015; group 2 [n=61], operation date 2016–2017). Pathologic slides in group 1 were reviewed to distinguish men with cribriform pattern (CP) because the determination of Gleason scores in old era had been based on pre-ISUP2014 classification. Postoperative outcomes in the two eras were analyzed twice: first, all men in group 1 vs. group 2; second, the remaining men after excluding those with CPs in group 1 vs. group 2.
Results
The proportion of men with insignificant prostate cancer (iPCa) was significantly lower in group 1 than in group 2 (36.8% vs. 57.4%, p=0.040). After excluding 11 men with CPs from group 1, those remaining (46 men) were compared again with group 2. In this analysis, the proportion of men with iPCa was similar between the two groups (old vs. contemporary era: 41.3% vs. 57.4%, p=0.146). Nine of 11 men with CP had violated the criteria for iPCa in the earlier comparison.
Conclusions
The accuracy of the AS protocol has been affected by the coexistence of CPs and pure Gleason 6 tumors in the pre-ISUP2014 era. We suggest to use only contemporary (post-ISUP2014) data to analyze the accuracy with AS protocols in future studies.

Keyword

Neoplasm grading; Prostatectomy; Prostatic neoplasms; Watchful waiting