{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:52:29Z","timestamp":1785408749684,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["PI22\/01769"],"award-info":[{"award-number":["PI22\/01769"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["PI25\/01318"],"award-info":[{"award-number":["PI25\/01318"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"award":["PI22\/01769"],"award-info":[{"award-number":["PI22\/01769"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]},{"award":["PI25\/01318"],"award-info":[{"award-number":["PI25\/01318"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Active surveillance (AS) criteria in prostate cancer (PCa) are expanding to include selected patients with intermediate-risk features. This multicenter retrospective study aimed to validate a proposed risk group (RG) classification for predicting unfavorable pathology (UP) in radical prostatectomy specimens among patients eligible for AS under expanded criteria. Methods: Patients from three Andalusian university hospitals who met the AS criteria, defined as prostate-specific antigen (PSA) \u2264 20 ng\/mL, International Society of Urological Pathology (ISUP) \u2264 2, and clinical stage \u2264 cT2, were included. The patients were stratified into five RGs according to PSA density, Prostate Imaging Reporting and Data System score (PI-RADS), and clinical stage. UP was defined as \u2265pT3a and\/or pN+ and\/or ISUP grade \u2265 3. Results: A total of 244 patients were analyzed. The median age was 63 years, the median PSA 5.98 ng\/mL, and the median PSA density was 0.14 ng\/cc. UP was identified in 47.1% of radical prostatectomy specimens, increasing progressively across RGs from 20.8% to 93.3%. Each incremental RG was associated with a higher risk of UP, with an odds ratio of 2.14 and moderate predictive accuracy, as reflected by an area under the curve of 0.70. Conclusions: The proposed RG classification showed moderate predictive capacity for UP and may improve risk stratification in intermediate-risk patients considered for AS.<\/jats:p>","DOI":"10.3390\/diagnostics16132073","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T10:04:44Z","timestamp":1782986684000},"page":"2073","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multicenter Validation of a Risk Classification Cluster for Unfavorable Pathology in Prostatectomy Specimens of Patients with an Active Surveillance Expanded Inclusion Criteria"],"prefix":"10.3390","volume":"16","author":[{"given":"Maria Graus","family":"Romero","sequence":"first","affiliation":[{"name":"Urology Department, Reina Sof\u00eda University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6106-5755","authenticated-orcid":false,"given":"Cristobal Cobo","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Urology Department, Virgen de la Victoria University Hospital, Genitourinary Oncology Translational Research Unit, Institute of Biomedical Research of Malaga (IBIMA Plataforma BIONAND), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo Lend\u00ednez","family":"Cano","sequence":"additional","affiliation":[{"name":"Urology Department, Virgen del Roc\u00edo University Hospital, Institute of Biomedical Research of Seville (IBIS), University of Seville, 41013 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-4910","authenticated-orcid":false,"given":"Laura Chamorro","family":"Castillo","sequence":"additional","affiliation":[{"name":"Urology Department, Reina Sof\u00eda University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Andres Guti\u00e9rrez","family":"Suarez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Cordoba (UCO), 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-5754","authenticated-orcid":false,"given":"Juan Pablo Campos","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Urology Department, Reina Sof\u00eda University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6235-4897","authenticated-orcid":false,"given":"Bernardo Herrera","family":"Imbroda","sequence":"additional","affiliation":[{"name":"Urology Department, Virgen de la Victoria University Hospital, Genitourinary Oncology Translational Research Unit, Institute of Biomedical Research of Malaga (IBIMA Plataforma BIONAND), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Angel Medina","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Urology Department, Virgen del Roc\u00edo University Hospital, Institute of Biomedical Research of Seville (IBIS), University of Seville, 41013 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8753-3306","authenticated-orcid":false,"given":"Enrique G\u00f3mez","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Urology Department, Reina Sof\u00eda University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e077738","DOI":"10.1136\/bmj-2023-077738","article-title":"Prostate cancer incidence and mortality in Europe and implications for screening activities: Population-based study","volume":"386","author":"Vaccarella","year":"2024","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/nrurol.2017.26","article-title":"Expert consensus document: Semantics in active surveillance for men with localized prostate cancer\u2014Results of a modified Delphi consensus procedure","volume":"14","author":"Bruinsma","year":"2017","journal-title":"Nat. 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Cancer"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2073\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T04:43:51Z","timestamp":1783140231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":26,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16132073"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16132073","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}