JapaneseUrological Association 54(86) 23 e( ± ) gg14ft$ (SS8) 23 H( ± ) bl142S Active surveillance for men with newly diagnosed prostate cancer : critical role of pathology johns Hopkins Medical lnstitutions, USA Jonathan I. Epstein This talk with cover 25 years of work performed at The Johns Hopkins Hospital on the management of men with potentially insignificant prostate cancer. Data wM first be presented on the longterm prognosis of untreated stage Tla prostatic carcinoma (limited low grade

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... ancer on TURP). When radical prostatectomy is performed for these men, most patients have minimal (insignificant) disease, yet about 24% have more substantial tumor which is impossible to predict based on TUR extent or grade within the Tla stage. Currently, TURPs have decreased with most cancers detected due to nonpalpable tumors diagnosed on needle biopsy as a result of elevated serurn PSA levels (Tlc). There is much evidence of overtreatrnent of prostate cancer in the PSA era, especially in older men, Since the 1980s, there has been an increase of minimal tumor detected at radical prostatectomy, In uncommon cases, no tumor is initially found in the radical prostatectomy specimen. We have developed a protocol to increase the likelihood of detecting cancer when initially no cancer is found. Currentiy, about 25% of radical prostatectomy specimens performed at our institution have potentially insignificant cancer (No Gleason pattern 4 ; organ confined caner ; and tumor volume50% cancer ; and PSAdensity800 men) active surveillance program with men undergoing yearly PSA measurements and biopsies. At enrollment a minimum of 12 core sampting is required. The criteria for recommending definitive therapy is solely based finding more advanced disease on repeat surveillance biopsy than our active surveillanee entry criteria. We have not found various PSA measurements to be useful in predicting more advanced disease. Data will also be presented on the risk of cancer dedifferentiation over time in this cohort. Based on radical prostatectomy findings in men who have undergone definitive therapy fo11owing more advanced disease on follow-up biopsy, we now sample on yearly repeat biopsy the anterior region of the prostate for a total of 14 cores. We are in the process of evaluating other tests to better predict which men can be followed safely with active surveillance. One of the more crucial questions in Urology is the need for improved methods to distingnish men with life threatening prostate cancer from those with indolent disease who will not benefit from treatment.