Page 68 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Table 2. Cohorts that used Gleason score and PSA as part of patient eligibility criteria for AS
Cohorts or Centers Gleason score PSA (ng/mL)
Baylor College of Medicine and MSKCC 106 <7
McGill University 107
UCHC 108
Four tertiary care academic medical canters 109 ≤6 ≤10
University of Miami 110 ≤6 ≤15; then changed to
≤10
UCSF 111 ≤6 with a priori <10 with a priori
d
b
exceptions exceptions
Royal Marsden Hospital 112 <3+4 ≤20 ; then changed to
≤15
Johns Hopkins 113 ≤6 PSA-d ≤0.15
c
c
Toronto 114 ≤6; ≤3+4 (if ≥70 yr) ≤10; <15 (if ≥70 yr)
MSKCC 115 No Gleason grade 4 or 5 <10
ProtecT (Prostate testing for cancer and Treatment
Trial) 116
Dana-Farber Cancer Institute 117 ≤6 with no pattern 4
Kagawa Medical University 118 ≤6 ≤20
Cleveland clinic 119 No Gleason grade 4 or 5 ≤10
PRIAS 120 ≤3+3=6 ≤10; PSA-d ≤ 0.2
PASS 121
Grey shading indicates that a study did not report use of a particular criterion; PSA-d = PSA density (ng/mL/cm3) which is
calculated by dividing the PSA level by the total volume of the prostate.
a The Gleason patterns range from 1 to 5, being 5 the least differentiated pattern. A Gleason score of 4+3 (primary + secondary
grade) = 7 is different from 3+4 = 7, and has a different prognosis as well. It is therefore more informative to give both patterns,
than just providing the sum of those (i.e., the Gleason score).
b Exception: having a Gleason pattern of 4 reported only in a microfocus of tumor
c (if ≥if yr) = for older patients (age ≥yr years), less than Gleason up to 3+4 criterion and PSA less than 15 was used.
d Exception: <15 for men with concurrent benign prostatic hyperplasia or prostatitis

Imaging. One cohort reported that a chest radiograph was mandatory, and bone scan and
computed tomography scan of the abdomen and pelvis were performed at the clinician’s
discretion. 114,125 One other cohort reported that magnetic resonance imaging of the prostate was
selectively used at diagnosis. 109

Behavioral indicators. No behavioral indicator was used explicitly as a criterion for AS
program enrollment.

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