930 AGE ADJUSTED VALIDATION OF THE MOST STRINGENT CRITERIA FOR ACTIVE SURVELLIANCE: IMPLICATIONS FOR PATIENT SELECTION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2010930 AGE ADJUSTED VALIDATION OF THE MOST STRINGENT CRITERIA FOR ACTIVE SURVELLIANCE: IMPLICATIONS FOR PATIENT SELECTION Suardi Nazareno, Alberto Briganti, Umberto Capitanio, Andrea Gallina, Andrea Salonia, Marco Bianchi, Firas Abdollah, Massimo Freschi, Pierre Karakiewicz, Patrizio Rigatti, and Francesco Montorsi Suardi NazarenoSuardi Nazareno Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Andrea SaloniaAndrea Salonia Milan, Italy More articles by this author , Marco BianchiMarco Bianchi Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Massimo FreschiMassimo Freschi Milan, Italy More articles by this author , Pierre KarakiewiczPierre Karakiewicz Montreal, Canada More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1746AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The currently used criteria for selecting patients for active surveillance do not take into consideration patient age which represents one of the most important parameter in the treatment decision planning. We tested the impact of patient age on pathological parameters in patients treated with radical prostatectomy (RP) who could have been selected for AS. METHODS The study included 1197 patients with treated with RP at a single institution. Only patients suitable for AS according to the criteria proposed by either Van den Bergh et al. (cT1-T2, biopsy Gleason ≤3+3, PSA≤10, PSA density<0.2 and positive core≤2 ) or Carter et al. (cT1, biopsy Gleason ≤3+3, PSA density≤0.15, positive core ≤2, <50% of cancer in any core) were selected. This resulted in 199 (16.6%) and 153 (12.8%) patients, respectively. Patients were divided in age categories according to tertiles (≤63, 63.1-69 and >69 yrs). We evaluated the number of patients suitable for AS and the rates of unfavorable prostate cancer characteristics at pathology (defined as Gleason score≥ 7, presence of non-organ confined disease) according to each age category. Pearson's correlations were used to test the differences between the age categories for each analysis. AUC analysis tested the accuracy of the criteria according to age. RESULTS Mean and median age was 64.7 and 65.6 years, respectively. Mean and median number of biopsy cores was 17.3 and 18, respectively. At RP, 26.6% (n=53) of patients suitable for AS according to Van den Bergh et al criteria had pathologically defined adverse prostate cancer. Interestingly, the rate of unfavorable prostate cancer significantly increased with patient age, being 22.6, 23 and 40.8% in patients aged ≤63, 63.1-69 and >69 yrs, respectively (p=0.04). The accuracy of the tested criteria in predicting adverse pathology decreased from 61% to 58.7% in younger (≤63) vs. older (>69) patients. Similar results were achieved when the criteria proposed by Carter et al were used. Overall, 22.2% (n=34) of patients had adverse pathological outcome at RP which significantly increased with patient age (16.7%, 16.3% and 40%; p=0.01). The accuracy of the criteria proposed by Carter et al ranged between 60.7% in younger patient vs. 56.5% in older patients. CONCLUSIONS Roughly 15% of patients treated with RP may be selected for AS protocols according to the Van den Bergh et al and the Carter et al. criteria. The performance of such criteria decrease with increasing patient age. Thus, care should be taken when applying these criteria in older patients who are generally considered more suitable for AS. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e362 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Suardi Nazareno Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Umberto Capitanio Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Andrea Salonia Milan, Italy More articles by this author Marco Bianchi Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Massimo Freschi Milan, Italy More articles by this author Pierre Karakiewicz Montreal, Canada More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...