We identify the biochemical outcome according to biopsy Gleason score (bGS) among patients who are clinical candidate for active surveillance. We found that different adverse pathologic outcomes and biochemical outcomes were shown according to biopsy pattern although the patients have the same pathologic Gleason score (pGS) 3+4 after RP.
To identify the biochemical recurrence rate (BCR) according to a pGS upgrade after radical prostatectomy among men with prostate cancer who are clinical candidates for active surveillance (AS) according to the Royal Marsden Hospital criteria.
Of the 956 patients with prostate cancer who met the Royal Marsden Hospital criteria for AS underwent radical prostatectomy between January 2006 and June 2014, we enrolled the 830 patients whose pGS was ≤ 3+4 in analysis. We stratified the patients into 3 groups according to the disparity between the bGS and pGS, as follows: group A (n = 211): bGS 3+3 to pGS 3+3; group B (n = 430): bGS 3+3 to pGS 3+4; group C (n = 189): bGS 3+4 to pGS 3+4.
The patients in group C had a higher preoperative prostate-specific antigen level, a higher percentage of positive cores, maximum core involvement (P < .001), and higher postoperative levels of extracapsular extension, seminal vesicle invasion, and positive surgical margins compared with the patients in groups A and B (P < .001, P = .002, and P < .001, for patients in groups C, B, and A, respectively). Group C had a significantly lower BCR-free survival rate compared with groups A and B via Kaplan-Meier, and no difference was observed in the BCR between groups A and B (log rank, P = .475).
Although the patients with the same pGS 3+4 after RP, different adverse outcomes were observed. Because of the significantly different prognosis based on the presence of Gleason pattern 4, patients with this pattern are not suitable for AS.
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- The contemporary concept of significant versus insignificant prostate cancer.Eur Urol. 2011; 60: 291-303
- Overdiagnosis and overtreatment of prostate cancer.Eur Urol. 2014; 65: 1046-1055
- Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer.J Clin Oncol. 2010; 28: 126-131
- Active surveillance for prostate cancer: progress and promise.J Clin Oncol. 2011; 29: 3669-3676
- Active surveillance for prostate cancer: trials and tribulations.World J Urol. 2008; 26: 437-442
- A multi-institutional evaluation of active surveillance for low risk prostate cancer.J Urol. 2013; 189: S19-S25
- Active surveillance program for prostate cancer: an update of the Johns Hopkins experience.J Clin Oncol. 2011; 29: 2185-2190
- Active surveillance for prostate cancer: a systematic review of the literature.Eur Urol. 2012; 62: 976-983
- Expanded criteria to identify men eligible for active surveillance of low risk prostate cancer at Johns Hopkins: a preliminary analysis.J Urol. 2013; 190: 2033-2038
- Population based study of predictors of adverse pathology among candidates for active surveillance with Gleason 6 prostate cancer.J Urol. 2014; 191: 350-357
- Patient selection and pathological outcomes using currently available active surveillance criteria.BJU Int. 2013; 112: 471-477
- Outcomes of active surveillance for men with intermediate-risk prostate cancer.J Clin Oncol. 2011; 29: 228-234
- Prostate cancer overdiagnosis and overtreatment.Curr Opin Endocrinol Diabetes Obes. 2013; 20: 204-209
- Outcomes of initially expectantly managed patients with low or intermediate risk screen-detected localized prostate cancer.BJU Int. 2012; 110: 1672-1677
- Active surveillance: patient selection.Curr Opin Urol. 2013; 23: 239-244
- The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma.Am J Surg Pathol. 2005; 29: 1228-1242
- Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance.Eur Urol. 2008; 54: 1297-1305
- Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin - A multicenter study.Radiother Oncol. 2015; 116: 119-124
- Comorbid disease burden is independently associated with higher-risk disease at prostatectomy in patients eligible for active surveillance.J Urol. 2015; (pii: S0022-5347(15)05140-X. [Epub ahead of print])http://dx.doi.org/10.1016/j.juro.2015.10.120
- Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes.J Urol. 2007; 177: 540-545
- Systematic review and meta-analysis of factors determining change to radical treatment in active surveillance for localized prostate cancer.Eur Urol. 2015; 67: 993-1005
- What is the optimal definition of misclassification in patients with very low-risk prostate cancer eligible for active surveillance? Results from a multi-institutional series.Urol Oncol. 2015; 33: 164.e1-164.e9
- Can we expand active surveillance criteria to include biopsy Gleason 3+4 prostate cancer? A multi-institutional study of 2,323 patients.Urol Oncol. 2015; 33: 71.e1-71.e9
- Analysis of expanded criteria to select candidates for active surveillance of low-risk prostate cancer.Asian J Androl. 2015; 17: 248-252
- Can contemporary patients with biopsy Gleason score 3+4 be eligible for active surveillance?.PLoS One. 2014; 9: e109031
- Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer.Mod Pathol. 2015; 28: 457-464
- Validation of active surveillance criteria for pathologically insignificant prostate cancer in Asian men.Int J Urol. 2016; 23: 49-54
- Low-risk prostate cancer patients without visible tumor (T1c) on multiparametric MRI could qualify for active surveillance candidate even if they did not meet inclusion criteria of active surveillance protocol.Jpn J Clin Oncol. 2013; 43: 553-558
- Role of multiparametric 3.0-Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance.BJU Int. 2014; 113: 864-870
- Multiparametric magnetic resonance imaging findings in men with low-risk prostate cancer followed using active surveillance.BJU Int. 2013; 111: 1037-1045
Published online: January 21, 2016
Accepted: January 16, 2016
Received in revised form: December 29, 2015
Received: September 24, 2015
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