College of American Pathologists Publishes Recommendations for Prostate Cancer Active Surveillance

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Recommendations from the United States Preventive Services Task Force and randomized trials have drawn attention to overtreatment of localized, low-risk prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to the overdiagnosis and overtreatment of prostate cancer.

Active surveillance offers low-risk prostate cancer patients a means to avoid the potentially harmful side effects from treatment.  Pathologists help determine patient eligibility for active surveillance, and recently a multispecialty team published their recommendations for making such determinations.1

Active Surveillance

With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.

“Active surveillance is an important management option for men with low-risk prostate cancer,” says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles. “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.”

Pathologic Parameters

Dr. Amin spearheaded the team that highlighted the pathologic parameters key for the successful identification of patients likely to succeed with active surveillance. The key parameters, at a general level, address:

  • Sampling, submission, and processing issues in needle biopsies used to diagnose prostate cancer
  • Tumor extent in needle biopsies
  • Biopsy reporting for all and special cases
  • Gleason scores, the system for grading prostate cancer tissue based on how it looks under a microscope
  • Precision medicine markers
  • Other pathologic considerations

The team further concluded that the key parameters to be reported by the surgical pathologists: (1) need to be reproducible and consistently reported and (2) highlight the importance of accurate pathology reporting. ■

Disclosure: Dr. Amin reported no potential conflicts of interest. The article’s authors include pathologists, radiation oncologists, surgeons, and urologists from Australia, Canada, Italy, New Zealand, Sweden, and the United States. For a full list of study authors, visit www.

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.


1. Amin, MB, Lin DW, Gore JL, et al: Arch Pathol Lab Med. August 5, 2014 (early release online).