Rate of misclassification in patients undergoing radical prostatectomy but fulfilling active surveillance criteria according to the European Association of Urology guidelines on prostate cancer: a high-volume center experience

BACKGROUND: The aim of the study was to identify the rate of pathologic upgrading and upstaging in a cohort of patients diagnosed with prostate cancer (PCa) who met inclusion criteria for active surveillance (AS) by the European Association of Urology (EAU) guidelines on prostate cancer but decided to undergo radical prostatectomy (RPE). Our goal was to determine possible predictive parameters that may be associated with unfavorable disease. METHODS: Single center retrospective analysis of patients who underwent RPE despite qualifying for AS according to the EAU AS criteria (defined as PSA <= 10 ng/mL, biopsy Gleason Score < 7, clinical stage <= T2a, <= 2 positive biopsy cores and <= 50% cancer involvement of every positive core). Based on the final histopathology report we evaluated the rates of Gleason Score upgrading and upstaging to non-organ confined disease. Multivariate logistic regression analysis was performed to identify preoperative parameters that may correlate with disease upgrading and upstaging. RESULTS: Among 2345 patients, who underwent RPE between March 2007 and October 2013, 372 were included in our study. Final pathology report revealed Gleason Score upgrading in 105 (28.2%) patients and an extraprostatic extension (upstaging >= pT3a) in 24 (6.4%) patients. There was no preoperative parameter that correlated statistically significantly with unfavorable disease. CONCLUSIONS: Our results indicate that the current criteria for AS cannot reliably differentiate between clinically significant or insignificant PCa and therefore offer limited utility in patient selection. Inclusion of more reliable tools like mpMRI novel biological markers might contribute to refine the current AS criteria.