The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients With Prostate Cancer

Mahul B. Amin, Daniel W. Lin, John L. Gore, John R. Srigley, Hema Samaratunga, Lars Egevad, Mark Rubin, John Nacey, H. Ballentine Carter, Laurence Klotz, Howard Sandler, Anthony L. Zietman, Stuart Holden, Rodolfo Montironi, Peter A. Humphrey, Andrew J. Evans, Brett Delahunt, Jesse K. McKenney, Dan Berney, Thomas M. Wheeler, Arul M. Chinnaiyan, Lawrence True, Beatrice Knudsen, and Elizabeth Hammond (2014) The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients With Prostate Cancer: Consensus Statement With Recommendations Supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists and the Prostate Cancer Foundation. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients With Prostate Cancer: Consensus Statement With Recommendations Supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists and the Prostate Cancer Foundation

Mahul B. Amin, MD; Daniel W. Lin, MD; John L. Gore, MD, MS; John R. Srigley, MD, FRCPC, FRCPath; Hema Samaratunga, MBBS, FRCPA; Lars Egevad, MD; Mark Rubin, MD; John Nacey, MD; H. Ballentine Carter, MD; Laurence Klotz, MD; Howard Sandler, MD;Anthony L. Zietman, MD; Stuart Holden, MD; Rodolfo Montironi, MD, FRCPath, IFCAP; Peter A. Humphrey, MD, PhD; Andrew J.Evans, MD; Brett Delahunt, MD; Jesse K. McKenney, MD; Dan Berney, MD; Thomas M. Wheeler, MD; Arul M. Chinnaiyan, MD, PhD;Lawrence True, MD; Beatrice Knudsen, MD, PhD; Elizabeth Hammond, MD

From the Departments of Pathology and Laboratory Medicine (Drs Amin and Knudsen),

Radiation Oncology (Dr Sandler),

Urology (Dr Holden),

and Biomedical Sciences (Dr Knudsen),

Cedars-Sinai Medical Center, Los Angeles, California; the Departments of Urology (Drs Lin and Gore)

and Pathology (Dr True),

University of Washington, Seattle; Trillium Health Partners, Mississauga, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada (Dr Srigley);

Aquesta Pathology, Toowong, Queensland, Australia, and the University of Queensland, Brisbane (Dr Samaratunga);

the Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden (Dr Egevad);

the Institute for Precision Medicine and the Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, Ithaca, New York, and New York-Presbyterian Hospital, New York (Dr Rubin);

the Departments of Surgery (Dr Nacey)

and Pathology and Molecular Medicine (Dr Delahunt),

Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand; the James Buchanan Brady Urological Institute (Dr Carter)

and the Departments of Pathology (Dr Epstein),

Urology (Dr Epstein),

and Oncology (Dr Epstein),

Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Urology, the Sunnybrook Health Sciences Centre (Dr Klotz)

and the University Health Network (Dr Evans),

University of Toronto, Toronto, Ontario, Canada; the Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Zietman);

the Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Polytechnic University of the Marche Region, Ancona, Italy (Dr Montironi);

the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Humphrey);

the Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (Dr McKenney);

the Department of Cellular Pathology, The Royal London Hospital, London, England (Dr Berney);

the Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas (Dr Wheeler);

the Michigan Center for Translational Pathology, University of Michigan, Ann Arbor (Dr Chinnaiyan);

and the Department of Pathology, Section of Electron Microscopy, University of Utah School of Medicine, Salt Lake City (Dr Hammond).

Context.— Prostate cancer remains a significant public health problem. Recent publications of randomized trials and the US Preventive Services Task Force recommendations have drawn attention to overtreatment of localized, low-risk prostate cancer. Active surveillance, in which patients undergo regular visits with serum prostate-specific antigen tests and repeat prostate biopsies, rather than aggressive treatment with curative intent, may address overtreatment of low-risk prostate cancer. It is apparent that a greater awareness of the critical role of pathologists in determining eligibility for active surveillance is needed.

Objectives.— To review the state of current knowledge about the role of active surveillance in the management of prostate cancer and to provide a multidisciplinary report focusing on pathologic parameters important to the successful identification of patients likely to succeed with active surveillance, to determine the role of molecular tests in increasing the safety of active surveillance, and to provide future directions.

Design.— Systematic review of literature on active surveillance for low-risk prostate cancer, pathologic parameters important for appropriate stratification, and issues regarding interobserver reproducibility. Expert panels were created to delineate the fundamental questions confronting the clinical and pathologic aspects of management of men on active surveillance.

Results.— Expert panelists identified pathologic parameters important for management and the related diagnostic and reporting issues. Consensus recommendations were generated where appropriate.

Conclusions.— Active surveillance is an important management option for men with low-risk prostate cancer. Vital to this process is the critical role pathologic parameters have in identifying appropriate candidates for active surveillance. These findings need to be reproducible and consistently reported by surgical pathologists with accurate pathology reporting.