Virchows Archiv

, Volume 465, Issue 6, pp 623–628 | Cite as

Consensus statement with recommendations on active surveillance inclusion criteria and definition of progression in men with localized prostate cancer: the critical role of the pathologist

  • Rodolfo MontironiEmail author
  • Elizabeth H. Hammond
  • Daniel W. Lin
  • John L. Gore
  • John R. Srigley
  • Hema Samaratunga
  • Lars Egevad
  • Mark A. Rubin
  • John Nacey
  • Laurence Klotz
  • Howard Sandler
  • Anthony L. Zietman
  • Stuart Holden
  • Peter A. Humphrey
  • Andrew J. Evans
  • Brett Delahunt
  • Jesse K. McKenney
  • Daniel Berney
  • Thomas M. Wheeler
  • Arul Chinnaiyan
  • Lawrence True
  • Beatrice Knudsen
  • Jonathan I. Epstein
  • Mahul B. Amin
Meeting Report


Active surveillance (AS) is an important management option for men with low-risk, clinically localized prostate cancer. The clinical parameters for patient selection and definition of progression for AS protocols are evolving as data from several large cohorts matures. Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for AS. These findings need to be reproducible and consistently reported by surgical pathologists. This report highlights the importance of accurate pathology reporting as a critical component of these protocols.


Localized prostate cancer Low-risk prostate cancer Active surveillance Overtreatment Accurate pathology reporting 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, Carroll PR, Investigators CPSURE (2004) The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. J Urol 171:1393–1401PubMedCrossRefGoogle Scholar
  2. 2.
    Albertsen PC, Hanley JA, Fine J (2005) 20-Year outcomes following conservative management of clinically localized prostate cancer. JAMA 293:2095–2101PubMedCrossRefGoogle Scholar
  3. 3.
    Cooperberg MR, Broering JM, Carroll PR (2010) Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 28:1117–1123PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Stephenson AJ, Kattan MW, Eastham JA, Bianco FJ Jr, Yossepowitch O, Vickers AJ, Klein EA, Wood DP, Scardino PT (2009) Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol 27:4300–4305PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Etzioni R, Penson DF, Legler JM, di Tommaso D, Boer R, Gann PH, Feuer EJ (2002) Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 94:981–990PubMedCrossRefGoogle Scholar
  6. 6.
    Johansson JE, Andren O, Andersson SO, Dickman PW, Holmberg L, Magnuson A, Adami HO (2004) Natural history of early, localized prostate cancer. JAMA 291:2713–2719PubMedCrossRefGoogle Scholar
  7. 7.
    McGregor M, Hanley JA, Boivin JF, McLean RG (1998) Screening for prostate cancer: estimating the magnitude of overdetection. CMAJ 159:1368–1372PubMedCentralPubMedGoogle Scholar
  8. 8.
    Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Barry MJ, Zietman A, O’Leary M, Walker-Corkery E, Yao SL (2009) Outcomes of localized prostate cancer following conservative management. JAMA 302:1202–1209PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid HP, van der Kwast T, Wiegel T, Zattoni F (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71PubMedCrossRefGoogle Scholar
  10. 10.
    Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, D’Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen CM, AUA Prostate Cancer Clinical Guideline Update Panel (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177:2106–2131PubMedCrossRefGoogle Scholar
  11. 11.
    Network NCC (2010) NCCN clinical practice guidelines in oncology: prostate cancer. Available at:
  12. 12.
    Dall’Era MA, Cooperberg MR, Chan JM, Pickles T, Kakehi Y, Rannikko A, Bjartell A, van der Schoot DK, Cornel EB, Conti GN, Boevé ER, Staerman F, Vis-Maters JJ, Vergunst H, Jaspars JJ, Strölin P, van Muilekom E, Schröder FH, Bangma CH, Roobol MJ (2008) Active surveillance for early-stage prostate cancer: review of the current literature. Cancer 112:1650–1659PubMedCrossRefGoogle Scholar
  13. 13.
    Xia J, Trock BJ, Cooperberg MR, Gulati R, Zeliadt SB, Gore JL, Lin DW, Carroll PR, Carter HB, Etzioni R (2012) Prostate cancer mortality following active surveillance versus immediate radical prostatectomy. Clin Cancer Res 18:5471–5478PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ganz PABJ, Burke W, Col NF, Corso PS, Dodson E, Hammond ME, Kogan BA, Lynch CF, Newcomer L, Seifter EJ, Tooze JA, Viswanath K, Wessells H (2011) National institutes of health state-of-the-science conference statement: role of active surveillance in the management of men with localized prostate cancer. NIH Consens State Sci Statement 28:1–27Google Scholar
  15. 15.
    Amin MB, Lin DW, Gore JL, Srigley JR, Samaratunga H, Egevad L, Rubin M, Nacey J, et al. (2014) The critical role of the pathologist in determining eligibility for active surveillance as a management options in patients with prostate cancer: consensus statement with recommendations supported by the college of american pathologist, international society of urologic pathologist, association of directors of anatomic and surgical pathology, the New Zealand society of pathologists and the prostate cancer foundation. Arch Pathol Lab MedGoogle Scholar
  16. 16.
    Bul M, Zhu X, Valdagni R, Pickles T, Kakehi Y, Rannikko A, Bjartell A, van der Schoot DK, Cornel EB, Conti GN, Boevé ER, Staerman F, Vis-Maters JJ, Vergunst H, Jaspars JJ, Strölin P, van Muilekom E, Schröder FH, Bangma CH, Roobol MJ (2013) Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol 63:597–603PubMedCrossRefGoogle Scholar
  17. 17.
    Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 28:126–131PubMedCrossRefGoogle Scholar
  18. 18.
    Tosoian JJ, Trock BJ, Landis P, Feng Z, Epstein JI, Partin AW, Walsh PC, Carter HB (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29:2185–2190PubMedCrossRefGoogle Scholar
  19. 19.
    Montironi R, Lopez-Beltran A, Mazzucchelli R, Scarpelli M, Galosi AB, Cheng L (2014) Contemporary update on pathology-related issues on routine workup of prostate biopsy: sectioning, tumor extent measurement, specimen orientation, and immunohistochemistry. Anal Quant Cytol Histol 36:61–70Google Scholar
  20. 20.
    Montironi R, Scarpelli M, Mazzucchelli R, Cheng L, Lopez-Beltran A, Montorsi F (2012) Extent of cancer of less than 50 % in any prostate needle biopsy core: how many millimeters are there? Eur Urol 61:751–756PubMedCrossRefGoogle Scholar
  21. 21.
    Brimo F, Vollmer RT, Corcos J, Kotar K, Begin RL, Humphrey PA, Bismar TA (2008) Prognostic value of various morphometric measurements of tumour extent in prostate needle core tissue. Histopathology 53:177–183PubMedCrossRefGoogle Scholar
  22. 22.
    Karram S, Trock BJ, Netto GJ, Epstein JI (2011) Should intervening benign tissue be included in the measurement of discontinuous foci of cancer on prostate needle biopsy? Correlation with radical prostatectomy findings. Am J Surg Pathol 35:1351–1355PubMedCrossRefGoogle Scholar
  23. 23.
    Schultz L, Maluf CE, da Silva RC, Falashi Rde H, da Costa MV, Schultz MI (2013) Discontinuous foci of cancer in a single core of prostatic biopsy: when it occurs and performance of quantification methods in a private-practice setting. Am J Surg Pathol 37:1831–1836PubMedCrossRefGoogle Scholar
  24. 24.
    Epstein JI (2010) An update of the Gleason grading system. J Urol 183:433–440PubMedCrossRefGoogle Scholar
  25. 25.
    Simon RM, Paik S, Hayes DF (2009) Use of archived specimens in evaluation of prognostic and predictive biomarkers. J Natl Cancer Inst 101:1446–1452PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Rodolfo Montironi
    • 1
    Email author
  • Elizabeth H. Hammond
    • 2
  • Daniel W. Lin
    • 3
  • John L. Gore
    • 3
  • John R. Srigley
    • 4
  • Hema Samaratunga
    • 5
  • Lars Egevad
    • 6
  • Mark A. Rubin
    • 7
  • John Nacey
    • 8
  • Laurence Klotz
    • 9
  • Howard Sandler
    • 10
  • Anthony L. Zietman
    • 11
  • Stuart Holden
    • 12
  • Peter A. Humphrey
    • 13
  • Andrew J. Evans
    • 14
  • Brett Delahunt
    • 15
  • Jesse K. McKenney
    • 16
  • Daniel Berney
    • 17
  • Thomas M. Wheeler
    • 18
  • Arul Chinnaiyan
    • 19
  • Lawrence True
    • 20
  • Beatrice Knudsen
    • 21
  • Jonathan I. Epstein
    • 22
  • Mahul B. Amin
    • 23
  1. 1.Section of Pathological Anatomy, School of Medicine, United HospitalsPolytechnic University of the Marche RegionAnconaItaly
  2. 2.Department of Pathology, School of MedicineUniversity of UtahSalt Lake CityUSA
  3. 3.Department of UrologyUniversity of WashingtonSeattleUSA
  4. 4.Trillium Health PartnersMississauga and McMaster UniversityHamiltonCanada
  5. 5.Aquesta Pathology & University of QueenslandBrisbaneAustralia
  6. 6.Department of PathologyKarolinska University HospitalStockholmSweden
  7. 7.Institute for Precision Medicine and the Department of Pathology and Laboratory MedicineWeill Medical College of Cornell University and New York-Presbyterian HospitalNew YorkUSA
  8. 8.Department of Surgery, Wellington School of Medicine and Health SciencesUniversity of OtagoWellingtonNew Zealand
  9. 9.Division of Urology, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  10. 10.Department of Radiation OncologyCedars-Sinai Medical CenterLos AngelesUSA
  11. 11.Department of Radiation Oncology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  12. 12.Department of Urology, School of MedicineUCLALos AngelesUSA
  13. 13.Department of Pathology, School of MedicineYale UniversityNew HavenUSA
  14. 14.University Health NetworkUniversity of TorontoTorontoCanada
  15. 15.Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health SciencesUniversity of OtagoWellingtonNew Zealand
  16. 16.Pathology and Laboratory Medicine InstituteCleveland Clinic FoundationClevelandUSA
  17. 17.Department of Cellular PathologyThe Royal London HospitalLondonUK
  18. 18.Department of Pathology and ImmunologyBaylor College of MedicineHoustonUSA
  19. 19.Michigan Center for Translational PathologyAnn ArborUSA
  20. 20.Department of PathologyUniversity of Washington Medical CenterSeattleUSA
  21. 21.Department of Biomedical Sciences and Department of Pathology & Laboratory MedicineCedars-Sinai Medical CenterLos AngelesUSA
  22. 22.Department of Pathology, Urology and OncologyJohns Hopkins School of MedicineBaltimoreUSA
  23. 23.Department of Pathology & Laboratory MedicineCedars-Sinai Medical CenterLos AngelesUSA

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