The Presence of High-grade Prostatic Intraepithelial Neoplasia or Atypia on Prostate Biopsy Does Not Adversely Affect Prostatectomy Outcomes for Patients Otherwise Eligible for Active Surveillance

Objective To investigate if the presence of concomitant high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on biopsy increases the risk of occult adverse pathology in patients otherwise suitable for active surveillance (AS). Methods Patients with D&#...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2014-12, Vol.84 (6), p.1442-1447
Main Authors: Pietzak, Eugene J, Kabarriti, Abdo E, Mucksavage, Phillip, Bavaria, Thomas, Van Arsdalen, Keith, Malkowicz, S. Bruce, Wein, Alan J, Guzzo, Thomas J
Format: Article
Language:English
Subjects:
Aged
Analysis of Variance
Biological and medical sciences
Biopsy, Needle
Cohort Studies
Disease-Free Survival
Humans
Immunohistochemistry
Male
Medical sciences
Middle Aged
Multivariate Analysis
Neoplasm Grading
Neoplasm Invasiveness - pathology
Neoplasm Recurrence, Local - mortality
Neoplasm Recurrence, Local - pathology
Neoplasm Staging
Nephrology. Urinary tract diseases
Patient Selection
Prognosis
Prospective Studies
Prostatectomy - methods
Prostatectomy - mortality
Prostatic Intraepithelial Neoplasia - mortality
Prostatic Intraepithelial Neoplasia - pathology
Prostatic Intraepithelial Neoplasia - surgery
Prostatic Intraepithelial Neoplasia - therapy
Prostatic Neoplasms - mortality
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Prostatic Neoplasms - therapy
Risk Assessment
Survival Analysis
Treatment Outcome
Tumors of the urinary system
Urinary tract. Prostate gland
Urology
Watchful Waiting
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Summary:Objective To investigate if the presence of concomitant high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) on biopsy increases the risk of occult adverse pathology in patients otherwise suitable for active surveillance (AS). Methods Patients with D'Amico low-risk prostate cancer on ≥10-core biopsy who underwent radical prostatectomy at our academic center were evaluated for eligibility for AS by either Epstein criteria or Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Prostatectomy specimens of patients eligible for AS were compared to determine if the presence of clinical HGPIN or ASAP affected the primary outcomes of pathologic upstaging and Gleason score upgrading. Results Of 553 patients with low-risk prostate cancer, 400 patients (72.3%) met the MSKCC criteria, whereas only 170 patients (30.7%) met the Epstein criteria. HGPIN was present in approximately 32%, and ASAP in approximately 12%, of each AS cohort. On univariate and multivariate analyses, HGPIN and ASAP had no impact on the rate of upgrading and upstaging in either Epstein or MSKCC AS-eligible patients. Furthermore, the presence of HGPIN and ASAP had no impact on the 5-year biochemical recurrence-free survival. Conclusion The presence of HGPIN or ASAP does not increase the risk of upgrading, upstaging, or adverse pathology at the time of prostatectomy for patients who meet the AS criteria. If otherwise suitable, HGPIN and ASAP should not impact the decision to choose AS. However, analysis of prospective AS trials is required to determine if HGPIN or ASAP impacts tumor progression once on AS.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2014.04.066