Patients with Biopsy Gleason Score 3 + 4 Are Not Appropriate Candidates for Active Surveillance

Abstract

Objective: The aim of this study was to evaluate the feasibility of including patients with biopsy Gleason score (bGS) 3 + 4 prostate cancer in an active surveillance (AS) protocol. Methods: A total of 615 patients underwent a radical prostatectomy and satisfied the following requirements: prostatespecific antigen ≤10 ng/dL, clinical stage T1c or T2a, 2 or fewer positive biopsy cores, and bGS 6 or 3 + 4 prostate cancer. The patients were divided into two groups according to their bGS (bGS 6 group, n = 534; bGS 3 + 4 group, n = 81). Results: The adverse pathological features were significantly higher in the bGS 3 + 4 group (16.7 vs. 49.4%, p < 0.001). Biochemical recurrence (BCR)-free survival was also significantly lower in this group (p < 0.001). In a multivariate analysis, clinical stage (odds ratio [OR] 2.026, p = 0.007), maximum percentage of biopsy core involvement (OR 1.015, p = 0.014), and bGS (OR 1.913, p = 0.030) were independent risk factors for adverse pathological features. However, the bGS was the only variable to forecast BCR (hazard ratio 3.567, p < 0.001). Conclusions:A bGS 3 + 4 was the leading risk factor for a worse postoperative prognosis. Therefore, patients with a bGS 3 + 4 are not appropriate candidates for AS.

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

“…Fourth, because only a small percentage of our patients had Gleason grade group 2 (5.9%), our study cannot recommend AS for IPC patients with intermediate risk profile. Particularly, since Gleason grade group 2 has been identified as a leading risk factor for adverse pathological features after RP [30].…”

Active Surveillance—Is It Feasible for Intermediate-risk Localised Prostate Cancer?

“…Additionally, Park et al [11] analysed the outcome of 534 LRPC and 81 IRPC (due to GS 3 + 4 only) patients who underwent radical prostatectomy, and noted that IRPC men had significantly higher adverse pathological features (16.7% vs 49.4%, p < 0.001) and significantly lower biochemical recurrence–free survival ( p < 0.001) in comparison with LRPC patients. GS 3 + 4 was found to be the only variable to predict PSA recurrence (HR 3.567, p < 0.001).…”