Abstract
Introduction
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.
Background
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 21, 2016
Accepted:
January 16,
2016
Received in revised form:
December 29,
2015
Received:
September 24,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
