Are current criteria eligible for active surveillance in patients with localized prostate cancer?

Background: We aimed to determine the parameters on the Gleason scoring system to upgrade in patients with the low-risk prostate cancer (PCa) that were suitable for active surveillance (AS). Methods: We retrospectively analyzed medical records of 153 patients who underwent radical prostatectomy because of PCa between 2007 and 2017. Potential predictors of upgrading were evaluated between the biopsy and surgical Gleason score. All patients had clinical low-risk PCa according to D’Amico risk classification. Demographic and clinical parameters including age, body mass index (BMI), Prostate Specific Antigen density (PSAD), and smoking status were evaluated. We examined the effects of recorded parameters on the Gleason scoring system to upgrade. All pathology materials were evaluated by an experienced pathology clinic. Significant p was accepted as p<0.05. Results: Median follow-up period was 113,4 months (range, 1-144 months). Mean age was 62.9± 6.07 years. Causes to upgrade in Gleason grading system were BMI≥30, PSA density≥0.15, to be an active smoker, and age≥ 65 years in Kaplan-Meier and log-rank tests analyses, respectively (all p<0.05). Univariate analyses showed that Age, BMI, PSA density≥0.15 and active smoker statuses were statistically significant prognostic factors (respectively; p:0.007, p<0.001, p<0.001, p<0.001). Conclusion: Current Criteria for AS could not be useful for all PCa low-risk PCa patients. AS does not seem to be appropriate for PCa patients with Elevated BMI