{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T15:20:01Z","timestamp":1774452001574,"version":"3.50.1"},"reference-count":75,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Active surveillance (AS) is a viable option for patients with low-risk\/low-burden prostate cancer (PCa). Approximately 40\u201350% of patients will develop disease progression and conversion to active treatment. Therefore, better risk stratification may aid patients and urologists to improve decision making. Herein, the proliferation marker Ki-67 was examined for its prognostic potential in AS patients. Methods: Fifty-nine patients were included. Median follow-up time was 58 months (range, 10\u2013162 months). Tumor-bearing biopsies were evaluated using immunohistochemistry (IHC) staining for Ki-67 and evaluated using digital imaging analysis to determine the percentage of Ki-67-positive PCa cells per biopsy. Results: Thirty-three of 59 patients (55.9%) developed progression. Thirty-one of 59 patients (52.5%) showed Ki-67-positive biopsies (median 0.8%; range, 0\u201311.9%). The median of Ki-67-positive cells was 1.5% (range, 0\u201311.9%) in patients with and 0% (range, 0\u20136.3%) in patients without progression. Comparing patients with Ki-67-positive and Ki-67-negative biopsies showed a worse progression free survival (PFS) in patients with Ki-67-positive biopsies after a period of 15 months, however, without reaching statistical significance (p = 0.071). A 5% threshold for Ki-67 positivity led to a significant difference in PFS. Further exploratory analysis revealed that patients with Ki-67-positive biopsies and aged \u226565 years or with &gt;1 tumor-bearing biopsy show a significantly worse outcome (p = 0.038 and p = 0.037, respectively). Conclusions: Our results suggest that patients with Ki-67-positive biopsies remaining in AS for &gt;1 year have an increased risk for PCa progression and conversion to treatment. Studies to further confirm Ki-67 as a marker for risk stratification, especially with a positivity cut-off of 5%, are warranted in larger cohorts of AS patients.<\/jats:p>","DOI":"10.3390\/diagnostics16070975","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T13:57:34Z","timestamp":1774447054000},"page":"975","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the Proliferation Marker Ki-67 for Improved Risk Stratification of Prostate Cancer Patients Under Active Surveillance"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2179-747X","authenticated-orcid":false,"given":"Viktoria","family":"Sch\u00fctz","sequence":"first","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maresa","family":"Rothermel","sequence":"additional","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"},{"name":"Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Kaczorowski","sequence":"additional","affiliation":[{"name":"Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svenja","family":"Dieffenbacher","sequence":"additional","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah Heike","family":"B\u00f6ning","sequence":"additional","affiliation":[{"name":"Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-2943","authenticated-orcid":false,"given":"Constantin","family":"Schwab","sequence":"additional","affiliation":[{"name":"Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albrecht","family":"Stenzinger","sequence":"additional","affiliation":[{"name":"Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7243-8958","authenticated-orcid":false,"given":"Johannes","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0168-4067","authenticated-orcid":false,"given":"Anette","family":"Duensing","sequence":"additional","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"},{"name":"Precision Oncology of Urological Malignancies, Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Hohenfellner","sequence":"additional","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Duensing","sequence":"additional","affiliation":[{"name":"Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany"},{"name":"Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Im Neuenheimer Feld 517, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref_1","first-page":"12","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA: A Cancer J. 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