Comparison of pathological outcomes of active surveillance candidates who underwent radical prostatectomy using contemporary protocols at a high-volume Korean center

Abstract

OBJECTIVE: We compared contemporary active surveillance protocols based on pathological outcomes in patients who underwent radical prostatectomy.

METHODS: We identified the experimental cohort from prostate cancer patients who underwent radical prostatectomy between 2001 and 2011 ; and who met the inclusion criteria of five published active surveillance protocols ; namely Johns Hopkins Medical Institution ; University of California at San Francisco ; Memorial Sloan-Kettering Cancer Center ; University of Miami and Prostate Cancer Research International: Active Surveillance. To compare each protocol ; we evaluated the pathological outcomes and calculated the sensitivity ; specificity and accuracy for each protocol according to the proportion of organ-confined Gleason≤6 disease.

RESULTS: Overall ; 376 patients met the inclusion criteria of the active surveillance protocols with 61 ; 325 ; 222 ; 212 and 206 patients meeting the criteria of the Johns Hopkins Medical Institution ; University of California at San Francisco ; Memorial Sloan-Kettering Cancer Center ; University of Miami and Prostate Cancer Research International: Active Surveillance protocols ; respectively. The sensitivity and specificity values of the five protocols ; respectively ; were 0.199 and 0.882 in Johns Hopkins Medical Institution ; 0.855 and 0.124 in University of California at San Francisco ; 0.638 and 0.468 in Memorial Sloan-Kettering Cancer Center ; 0.599 and 0.479 in University of Miami ; and 0.609 and 0.527 in Prostate Cancer Research International: Active Surveillance. In terms of both the sensitivity and specificity ; Prostate Cancer Research International: Active Surveillance was the most balanced protocol. In addition ; Prostate Cancer Research International: Active Surveillance showed a more accurate performance for favourable pathological outcomes than the others. However ; using the area under the curve to compare the discriminative ability of each protocol ; there were no statistically significant differences.

CONCLUSIONS: The contemporary active surveillance protocols showed similar pathological characteristics in patients who had undergone radical prostatectomy. However ; we concluded that the Prostate Cancer Research International: Active Surveillance protocol would be most helpful to Korean populations in choosing candidates for active surveillance considering the balance between sensitivity and specificity and the accuracy of diagnosis.