Percentage of cancer involvement in positive cores can predict unfavorable disease in men with low-risk prostate cancer but eligible for the prostate cancer international: Active surveillance criteria

Objectives: To identify predictive factors of unfavorable disease and of biochemical failure in patients treated with radical prostatectomy but eligible for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. We aimed to introduce and validate the percentage of cancer involvement in positive cores (CIPC) as potential worse predictive factor. Methods: From January 2002 to December 2007, 750 consecutive subjects underwent radical prostatectomy at a single institution. We identified 147 (19.05%) patients who were eligible for AS based on PRIAS criteria: clinical stage Tic or T2 disease, prostate-specific antigen level of <= 10 rig/ml, Gleason score <= 6, prostate-specific antigen-D of <0.2 ng/ml(2), and fewer than 3 positive biopsy cores. CIPC was included in the analysis. Results: Of the 147 patients, 95 (66.43%) patients had favorable disease, whereas 48 (33.57%) had unfavorable disease. In multivariate logistic regression, maximum cancer length (odds ratio 12.52, P < 0.01) and CEPC (odds ratio 1.70, P < 0.01) represented independent predictors of unfavorable prostate cancer. The area under the receiver operating characteristics curve analysis revealed significantly higher performance after including CIPC to the PRIAS criteria (0.61 vs. 0.94, P < 0.01). A cutoff of 0.4 mm of CIPC was set to predict unfavorable disease with 93% specificity, 76% sensibility, and 87% accuracy based on the receiver operating characteristics curve analysis. Finally, the 3- and 5-years biochemical recurrence (BCR)-free survival were significantly lower in subjects with CIPC >= 0.4 mm, 88.4 % and 81.0% vs. 97.8% and 95.7%, respectively (P < 0.01). Conclusions: Our findings suggest that the inclusion of CIPC to the prostate biopsy features could be helpful to avoid misclassification in patients eligible for AS according to the PRIAS criteria